Como, Alan Gordon ( F) if1'1Z
NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit
Bureau of Vital Records a.
Name First Middle Last Sex
Alan Gordon Corso Male
Date of Death Age If Veteran of U.S.Armed Forces,
09/14/2022 71 Years War or Dates ,a,.
Place of Death Hospital,Institution or
Z City,Town or Village South Glens Falls Village Street Address 102 Hudson Strait 1B;South Glens Falls Village,Naw York 12803
Mannerof Death Undetermined Pending
W EI Natural Cause ❑Acddent Harrricide lode
Circumstances Investigation
O Medical Certifier Name _ Title
Eugene l adue Coroner
Address
31 Woodlavim Ave.,Saratoga Springs,New York 12866
Death Certificate Filed village of South Glens Falls ti District Number Register Number
City,Town or Village 4524 7
Burial Date Cemetery,Crematory or Facility Namiy
1 ]
09/28/2022 Pine View Crematory
Entombment Address —mil.
Cremation Queensbury Town,New York
Donation
c Removal Date Place Removed
and/or and/or Held
NHold Address
0
d Date Point of
Cl) Transportation Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
OReinterment
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
F— Remains are Shipped,If Otherthan Above
S Address
Q
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/26/2022 Registrar of Vital Statistics Saarawdfra eel/gioctsbraca16,
(signature)
District Number 4524 Place Village Of South Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this parmiton:
Date of Disposition y/Zq la Place of Disposition '[ rnr V_-. 4.k—
LIJ
2 (address)
W
0
CC (section) (lot number) (grate number)
8 Name of Sexton or Person in Charge of Premises 4(2,--;f6--.. .<l¢
� /pase print/ /
W Signature ( Title C le fi)a. izK
DOH-1555(07/18)p t of 2
, 7 cl
4x
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
r - r
Pine View Cemetery Representing-the funeral home named yn burial permit
Official Funeral Directors Reg.or License#,' t i. 4,