Gagliano, Louis NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Louis J. Gagliano male
Date of Death Age If Veteran of U.S. Armed Forces,
10/05/1999 82 War or Dates n/a
Place of Death Hospital, Institution or
City, T�xxxeafdAtoe Glens Falls Street Address Eden Park Nursing Home
Manner of Death E Natural Cause 0 Accident El Homicide 0 Suicide ❑ Undetermined ❑Pending
141 Circumstances Investigation
W Medical Certifier Name Title
4 : Anthony Petracca, MD
i!ii Address
3 Irongale Center, Glens Falls, NY 12801
iiii Death Certificate Filed District Number Register Number
iiia City, TxxnraxeaVili gex Glens Falls 5601
Date Cemetery or Crematory
QX Burial 10/09/1999 Pine View Cemetery
Address
: ❑Cremation
WUc1kt1"' Road, Queensbury, NY
Date Place Removed
0 Removal and/or Held
-- and/or Address
gHold
0 Date Point of
N❑Transportation Shipment
5 by Common Destination
Carrier
:: Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
€ . Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Funeral Hdme 01594
Address
53 Quaker Road, Queensbury, NY 12804
>. Name of Funeral Firm Making Disposition or to Whom
F. Remains are Shipped, If Other than Above
IX Address
W
IX
iiii Permission is hereby granted to dispose of the human remains desc fibbed boy as i c ed.
Date Issued 10/8/99 Registrar of Vital Statistics ���1
(signature)
District Number 5601 Place City of Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
f-
WDate of Disposition 10/3/9 9 Place of Disposition P i n e View Cemetery , Q u e e n w b u r y , N Y
2 (address)
LLJ N Mohican 62 3
fr (section) (lot number) (grave number)
GName of Se or Person in Charge of Premises Rodney G . Mosher
_ (please print)
W Signature %--x Title S u p e r i n t e n d e n t
(over)
DOH-1555 (9/98)
GF,GLIANO0�C
r r!)
Lot No. 62
Address 1147 Webster Drive, Wilmington, DEL 19803 Section No.
Owner Mr . Louis J. Gagliano Plot Mohican
Date 9/19/91
'Approx. 200 Superficial ft. @
Location Bounded on North by Path, South by Vacant, East by Vacant .
West by Path.
Corner Posts
IN o. PaY a r—(1 em AI 0
4Lui 3 ;.?
Deed No. (and changes) 2375
Payment Record Paid in Full 9/19/91
_lam
Record of Interments
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1 I_ , .die-62' 1iw x _1 7- as I
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•2 ;4` \:care Q-►a-a,5 .s 4 �` : ' F>'
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3 I nuis J narglianp in/g/9g ,.
4 Mary Elizabeth Gagliano ( 9/15/12 )
S ti .j
6 I }✓ 1 x `�.cb
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8 / a ,2 yi .Si ,4
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Form No. 01 4- (' L-
r.,:..._....
„ME Gagliano , Louis J .
Age: 82 C:
Cause: Natu2a1
Lot Owner: Louis J . Gagliano
Lot # 62 Mohican
Grave # 3
Case # Concrete
Died: 10/5/99
Interred: 10/9/9 9
Undertaker: Regan & Denny