Cardinale, Edward A NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Edward A.Cardinale Male
Date of Death Age If Veteran of U.S.Armed Forces,
08/16/2023 67 Years War or Dates
F— Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
IL
p Manner of Death I I Natural Cause Accident ❑Homicide Suicide Undetermined Pending
W ' 1 Circumstances Investigation
U
W Medical Certifier Name Title
0 Marvin Davidowitz MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 384
L Burial Date Cemetery,Crematory or Facility Name
08/21/2023 Pine View Cemetery
Entombment
_ Address
IIICremation Queensbury Town,New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
0
O. Date Point of
fA Dransportation
CI Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
El 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
-. Remains are Shipped,If Other than Above
a Address
CC
W
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/18/2023 Registrar of Vital Statistics MeganYorn(Electronrca�Signed)
(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: �(
~ l 1 I ''yyam�,
Z Date of Disposition .a� a Place of Disposition a Q� �,Q �l (1j J� c1'�
`(address/
WIJJ
ccon
L t number/ (grave number)
Cr
0 Name of Sexton or Person in Charge of Premises Cdf1fm'i L- �e -�
z z (please print)
W Signature Yt. Title t _2A <1
DOH-1555(07/18)p 1 of 2 1
Public Health Law Sec. 4145(2b) 012994
Receipt
Human remains of delivered on , 20
• =sue 1 _I_
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
CARDINALE
NAME Edward A Cardinale Age: 67
Lot Owner: Arlene Cardinale
Lot# Cayuga #1 A7 Grave# 1
Case: Concrete
Died: 8.1 6.2 3 Interred:8.21 -2 3
Funeral Home: Regan Denny Stafford
Cemetery: Pine View
CARDINALE
Owner
Arlene Cardinale
Address Plot
14 Cardinale Cayuga #1
Phone # Lot #
518-7445764 A-7
Deed # Date
8-17-23
Cost Foundation Y - N
$700.00
Location
West-Vacant
East-Road
North-Vacant
South-Path
Remarks
I ACKNOWLEDGE TH RECE ' OF THE RULES AND REGULATIONS OF THE
PINE VIEW CEMETE Y:
,, GNATURE: • DATE: B.
SIGNATURE: DATE:
Record of Inte ments
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