Cordiale, Harold W. 0 ci cc)
NEW YORK STATE DEPARTMENT OF HEALTH Burial Transit Permit
Bureau of Vital Records --._�
Name First Middle Last Sex
Harold W Cordiale Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/12/2022 90 Years War or Dates 1950-1952
Place of Death Hospital,Institution or
Z City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc
W Manner of Death 0 Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
WMedical Certifier Name Title
G Carrie Miron PA
Address
319 Broadway,Fort Edward Town,New York 12828
Death Certificate Filed Town Of Fort Edward District Number Register Number
City,Town or Village 5755 91
Burial Date Cemetery,Crematory or Facility Name
12/14/2022 Pine View Crematory
Entombment Address
Cremation Queensbury,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
~ Hold Address
NQ
a Date Point of
(ry❑Transportation Shipment
p by Common
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
0 Reinterment
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
i— Remains are Shipped,If Other than Above
2 Address
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W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/13/2022 Registrar of Vital Statistics Aimee G Mahoney(E(ectronica(Cy Signed)
(signature)
District Number 5755 Place Town Of Fort Edward
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
Z Date of Disposition j 2 1 Is Z Z Place of Disposition
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1iJ (address)
W
V1 (section) d,, t.._......,(lot number/ (grave number)
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Name of Sexton or Person in Charge of ises (pt a print) /
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W Signature Title
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DOH-1555(07/18)p 1 of 2
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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#