Mancuso, Vincent Anthoney g6Z
NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Vincent Anthoney Mancuso Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/30/2022 23 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
UJ
p Manner of Death El Natural Cause Accident Homicide ESuicide ❑Undetermined n Pending
Circumstances Investigation
W Medical Certifier Name Title
Timothy Murphy Coroner
Address
52 Haviland Avenue,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 552
Burial Date Cemetery,Crematory or Facility Name
MIN 11/02/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
H Hold Address
0
CL Date Point of
N Transportation
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-Argyle 01077
Address
123 Main St,Argyle,New York 12809
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/02/2022 Registrar of Vital Statistics Megan Wolin(ECectronicalfySigned)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: /J
Z
LU Date of Disposition U�2�ZZ Place of Disposition 47,y
,2 (address
W
O (section) /jT (lot number) (grave number)
ci Name of Sexton or Person in Charge of Pre
(p ase print)
W Signature Title rft
DOH-1555(07/18)p 1 of 2
C 3 f
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# '