Martino,Frank LC--.0). sk 33.E
NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Frank Martino Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/18/2022 80 Years War or Dates
F. Place of Death Hospital,Institution or
3 Z City,Town or Village Schroon Town Street Address 1176 US-9 Route,Schroon Town,New York 12870
Manner of Death [1 Natural Cause ❑Accident ill Homicide Suicide []Undetermined []Pending
III ' I I 1
V Circumstances Investigation
WW Medical Certifier Name Title
CI
Kellie Valentine Coroner
Address
PO Box 132,Elizabethtown Town,New York 12932
Death Certificate Filed Town Of Schroon District Number Register Number
City,Town or Village 1563 4
EBurial Date Cemetery,Crematory or Facility Name
04/20/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
DDonation
D�Removal Date Place Removed
H and/or and/or Held
0 Hold Address
N❑Transportation Date Point of
O by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
�Reinterment
Permit Issued to Registration Number
Name of Funeral Home Edward L Kelly Funeral Home 00519
Address
PO Box 548,Schroon Lake,New York 12870
Name of Funeral Firm Making Disposition or to Whom
F- Remains are Shipped,If Other than Above
N Address
CC
W
a.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/20/2022 Registrar of Vital Statistics PatrkioSamna ne4
(signature)
District Number 1563 Place Town Of Schroon
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition N In I ZZ Place of Disposition ?I'll--
(address)
W
(section) !lot number) t (grave number)
2 Name of Sexton or Person in Charge of Premises th(i) �J1i
Z /,� ase print)
W Signature !—� �` — Title r�til
DOH 1555(07/18)p t of 2
`, _59 S 3
Public Health Law Sec. 4145(2b)
Receipt
Human remains of ' delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License#