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Esposito, Berle Anthony .6, 4' LF NEWYORKSTATEDEPARTMENTOFHEALTH \ Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Berle Anthony Esposito Male Date of Death Age If Veteran of U.S.Armed Forces, 06/06/2023 79 Years War or Dates F. Place of Death Hospital,Institution or Z City,Town or Village Horicon Town Street Address 65 Delaney Drive,Horicon Town, New York 12815 p Manner of Death IZ Natural Cause ❑Accident Homicide Suicide Undetermined Pending W Circumstances Investigation Ui Medical Certifier Name Title CI Charles Yun MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed Town Of Horicon District Number Register Number City,Town or Village 5654 2 Burial Date Cemetery,Crematory or Facility Name '— 06/07/2023 Pine View Crematorium Entombment _ Address ©Cremation Queensbury Town,New York Donation Z❑Removal Date Place Removed H and/or and/or Held N Hold Address 0 EL Date Point of W❑Transportation CI Common Shipment Carrier Destination Date Cemetery Address nDisinterment Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom E- Remains are Shipped,If Other than Above " Address IX W G" Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/07/2023 Registrar of Vital Statistics 7Crista£Wood"(ECectronicaCCySigned) (signature) District Number 5654 Place Town Of Horicon I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z Date of Disposition ��� Place of Disposition W `� 2 ` (address) W U) Q (section) S (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises r`� - 'li Z lease print) W Signature C Title "i Iva DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 1 Receipt Human remains of ' delivered on , 20 l Pine View Cemetery Representing the funeral home named,on burial permit Official Funeral Directors Reg.or License#