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Gagliano, Donna Marie DELAWARE HEALTH AND SOCIAL SERVICES Division of Public Health Office of Vital Statistics Burial-Transit Permit Authorization 16 Del. C., §3151 and 3152- This permit must accompany remains to destination. Per 16 Del. C., §3111 (b),noncompliance will result in a fine of not more than$1,000 or imprisonment of not more than 1 year,or both. Decedent Information (to be completed by Funeral Director) Name: (First,Middle,Last;AKAs,if any) DONNA MARIE GAGLIANO Sex: FEMALE SSN: 113-38-2567 Date of Birth: 06/12/1946 Age:(Years;Last Birthday) 75 Under 1 Year-Months: Under 1 Year-Days: Under 1 Day-Hours: Under 1 Day-lvtinutes: Birthplace:(City and State or Foreign Country) GLENS FALLS,NEW YORK Residence: (Street Address,Apt.#) 6525 LANCASTER PIKE City: HOCKESSIN State: DELAWARE Zip Code: 19707 County: NEW CASTLE Inside City Limits: 0 Yes ® No Ever in Armed Forces: 0 Yes 0 No Marrital Status: ❑ Married 0 Never Married ❑ Widowed 0 Divorced 0 Unknown Surviving Spouse's Name: (If wife,give last name prior to first marriage) Father's Name: (First,Middle,Last) NOT AVAILABLE Mother's Name: (First,Middle,Last name prior to first marriage) NOT AVAILABLE Informant Information (to be completed by Funeral Director) Informant's Name: JEREMY B.DEPUTY Relationship to Decedent: LEGAL REPRESENTATIVE Mailing Address: (Street and No.,City,State,Zip Code) 47 NOTRE DAME AVENUE NEW CASTLE DELAWARE 19720 Place of Death (to be completed by Funeral Director-check only one) If Death Occurred in Hospital: ® Inpatient ❑ Emergency Room/Outpatient 0 Dead on Arrival If Death Occurred Somewhere Other Than a Hospital: ❑ Nursing Home/Long-Term Care Facility 0 Hospice Facility ❑ Decedent's Home 0 Other(Specify) Facility Name(if not institution,give street and number): CCHS-CHRISTIANA HOSPITAL City,State,Zip Code: NEWARK, DELAWARE 19718 County of Death: NEW CASTLE Method of Disposition: ❑ Burial ® Cremation 0 Donation 0 Entombment ❑ Removal from state ❑ Other(Specify) Place of Disposition(Name of cemetery,crematory,other place): UNITED CREMATORY SERVICES City,State,Zip Code: NEWARK DELAWARE 19702 Name and Address of Funeral Facility: STRAND&FEELEY FUNERAL HOME 635 CHURCHMANS RD NEWARK NEW CASTLE DELAWARE 19702 Signature of Funeral Service Licensee or Other Agent: MATTHEW STRANO License Number: K1-0000623 Effective 07h0 1 2J1 Copy C_. form rnust _J �!id Non-Resident FuneralDirectors Jesse S.Cooper Building . 417 Federal Street . Dover . Delaware . 19901 5636 State of Delaware Department of Health Vital Records RECORD FOR INTERMENT OF CREMATED REMAINS Full Name of Decedent Donna Marie Gagliano Sex Female Race White Age 75 Cause of Death Pneumonia,Hyperlipidemia,Hypertension,Alzheimer's disease Place of Death Newark,DE New Castle Date of Death December 14,2021 Township,Borough,or City-County Name and Address of Person to Whom Strano&Feeley Family Funeral Home Remains are Given Name or Sent 635 Churchmans Road,Newark,DE 19702 Address Name of Crematory United Crematory Services Address of Crematory 635 Churchmans Road,Newark,DE 19702 (�y p ©,, December 21,2021 .JCX\�.t� I\Ia/t -- Date of Cremation Signature of Crematory Official This record will be completed by a crematory official in all cases where cremated remains are to be interred in a cemetery. It will be attached in an envelope to the outside of the receptacle containing the remains,but inside the shipping wrapper if any,and be retained by the cemetery as part of its records. Gagliano NAME Donna Gagliano Age: 75 Lot Owner: Louis J Gagliano Lot# Mohican 62 Grave# 1 Case: Urn Died: 1 2. 1 4.21 Interred: 1 .7.2 2 Funeral Home: Strano &Feeley Family FH Cemetery: Pine View GAGLIANO ,(LF Lot No. 62 Address 1147 Webster Drive, Wilmington, DEL 19803 Section No. Owner Mr . Louis J. Gagliano Plot Mohican Date 9/19/91 Approx. 200 Superficial ft. @ Location Bounded on North by Path, South by Vacant, East by Vacant . West by Path. Corner Posts Remarks L a t :i sv� a_ /; — C.: — 0 7 7- 6 1= ,- < No• PDX' e2f7n rm 4L ('/ 3 ;.? Deed No. (and changes) 2375 Payment Record Paid in Full 9/19/91 Record of Interments - La w &i I nui R J Gaol i anp 10/q/99 �} c 4 Mary Elizabeth Gagliano ( 9/15/12 ) 5 • ? i 8 — -5- ti Form No. 01 ,/c