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NEW YORK STATE DEPARTMENT OF HEALTH '`" `
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Thomas R.Neddo Sr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/10/2022 87 Years War or Dates 1950-54
WPlace of Death Hospital,Institution or
City,Town or Village Hartford Town Street Address 1292 Baldwin Corners Road,Hartford Town,New York 12827
p Manner of Death 0 Natural Cause Accident Homicide ESuicide ❑Undetermined ❑Pending
W
a Circumstances Investigation
iii Medical Certifier Name Title
Christopher Mason DO
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed Town Of Hartford District Number Register Number
City,Town or Village 5759 6
Burial Date Cemetery,Crematory or Facility Name
® 07/12/2022 Pineview Crematorium
Entombment Address
OCremation Queensbury Town,New York
Donation
Z Date Place Removed
O❑Removal
F= and/or and/or Held
as Hold Address
0
A Date Point of
Of:Transportation
2 by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
LIeinterment
R Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Mason Funeral Home 01117
Address
18 George St Po Box 277,Fort Ann,New York 12827-0277
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
, Address
c
111
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/12/2022 Registrar of Vital Statistics Denise Petteys(Electronically Signed)
(signature)
District Number 5759 Place Town Of Hartford
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition '111211Z Place of Disposition ?)Q�4.....
. 21-o---...."
tu
a; (address)
W
CC (section) d
(lot number) (grave number)
Name of Sexton or Person in Char of Premises NIS irf'
✓ (ple$se print)
Signature Title r 1M K
DOH-1555(07/18)p 1 of 2
ii
U
Public Health Law Sec. 4145(2b)
1 Receipt
,
Human remains of delivered on , 20 v.—
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1 Pine View Cemetery Representing the funeral home named/On btifial permit
Official Funeral Directors Reg.or License# t