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Luciano, Richard Francis NEW YORK STATE DEPARTMENT OF HEALTH (OS Bureau of Vital Records Burial Transit Permit Name First Middle Last Sex Richard Francis Luciano Male Date of Death Age If Veteran of U.S.Armed Forces, 01/26/2024 88 Years War or Dates F. Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc ci W Manner of Death Undetermined Pending Natural Cause Accident Homicide Suicide g W Circumstances Investigation W Medical Certifier Name Title CI Nicole Humiston NP 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 12 Burial Date Cemetery,Crematory or Facility Name 02/05/2024 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 0.. Date Point of Cl)OTransportation Q 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-Fort Edward 01079 Address 82 Broadway,Fort Edward, New York 12828 Name of Funeral Firm Making Disposition or to Whom I— Remains are Shipped,If Other than Above 5 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/29/2024 Registrar of Vital Statistics Aimee G Mahoney(ECectronicaCCy 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 2j 1.,(1t Place of Disposition 46rt g 2 (address) W N CC (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises �''�' L- t r Zj- (p ase print) W Signature Title 1V�� DOH-1555(07/18)p t of 2 ..i e C, 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#