Loading...
Treceno, Michael NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Michael Treceno Male Date of Death Age If Veteran of U.S.Armed Forces, 12/27/2021 67 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p• Manner of Death © Natural Cause Ej Accident 0 Homicide ❑Suicide Undetermined ❑Pending Circumstances Investigation • Medical Certifier Name Title Gamal Khalifa MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 630 ❑Burial Date Cemetery,Crematory or Facility Name 12/28/2021 Pine View Crematory ❑Entombment Address lCremation Queensbury Town,New York ▪Donation gRemoval Date Place Removed • and/or and/or Held ~ Hold Address 0 d Date Point of Cl) ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom I— Remains are Shipped,If Other than Above 5 Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/28/2021 Registrar of Vital Statistics Robert Andrew Curtis(Electronically Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: l— W Date of Disposition J� 1.-tdz/Place of Disposition P;4e iJ e„t j e�il/j l-'-e 2 (address,L,) W N CC (section) / (lot nu ber) (grave number) Name of Sexton or Person in Char of Premis l ) y�'1l7 N l ��'d Z (please print) Signature v K /� Title le�� DOH-1555(o7/18)p t of 2 r � b 3 Public Health Law Sec. 4145(2b) 1 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#