Catalfamo, John -7]NEW YORK STATE DEPARTMENT OF HEALTH.' / f
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
John A. Catalfamo Male
Date of Death Age If Veteran of U.S. Armed Forces,
' It% December 31, 2017 68 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Albany Street Address Albany Medical Center
uj
�` Manner of Death Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
M• edical Certifier Name Title
:0'' Patricia Northrup PC-C,
Address
New Scotland Ave Albany, NY 12208
Death Certificate Filed District Number Register Number
'. City, Town or Village A/64.✓1y O, ' / ,29A..9
_❑Burial Date •J Cemetery or Crematory
January 4, 2018 Pine View Crematorium
❑Entombment Address
itiM Quaker Road Queensbury,NY 12804
PI Date Place Removed
z❑ Removal and/or Held
and/or Address
Hold
A:; Date Point of
; ❑Transportation Shipment
(I) by Common Destination
Carrier
- 0 Disinterment
Date Cemetery Address
❑ Reinterment Date Cemetery Address
i Permit Issued to Registration Number
g' N• ame of Funeral Home Carleton Funeral Home, Inc. 00281
Address
t Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
i' "" Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
A Address
Permission is hereby granted to dispose of the human remains escribed above as indicated.
Registrar of Vital Statistics
Date Issued o 1�n 3��o i� 9 4-ku-G1--
. (sign e)
Ar.'; District Number DI o ( Place 0,5 0f' A 110 w
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 01/04/2018 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
it (section) 4 (lot num er) (grave number)
Name of Sexton or Person in Char a of Premises /141. M-A*
zE (please print)
S• ignature ./4rT Title IR M)I7
(over)
DOH-1555 (02/2004)