Garofalo, Frank NEW YaRK SATE DEPARTMENT OF HEALTH Vital Records Section
BUrI1I _ Transit Permit
r
��� Name First Middle Last Sex
''r' Frank S. Garofalo Male
'l Date of Death Age If Veteran of U.S. Armed Forces,
vet
August 24,2013 86 War or Dates
'% Place of Death Hospital, Institution or
City, Town or Village Fort Edward Street Address Fort Hudson Nursing Home
Manner of Death Natural Cause Accident Homicide n Suicide Undetermined n Pending
Circumstances Investigation
Medical Certifier Name �� L Gr ,,,T e
Address `� ��J
C 4
� Death Certificate Filed District Number Register Number
11City, Town or Village Fort Edward,NY Fort Edward,NY �j1..
yrG
®Burial Date Cemetery or Crematory
August 27, 2013 Pine View Cemetery
❑Entombment . Address
❑Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
ZZ in Removal and/or Held
and/or Address
H Hold
N
O Date Point of
NEl Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
1 Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
,' . Address
1 407 BayRoad,Queensbury, NY 12804
�;r�
?ig Name of Funeral Firm Making Disposition or to Whom
i;.r Remains are Shipped, If Other than Above
'' Address
rz Permission is h eby granted to dispose of the human e s descr' boveas indicated.
Date Issued Registrar of Vital Statis ics
.f (signature)
f District Number Place Fort Edward,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 8/27/1 3 Place of Disposition Pine View Cemetery
2 (address)
W
fn Erie 3A 2
IX (section) (lot number) (grave number)
pName of Sex n or Person in Charge of Premises Connie L. Goedert
Z (please print)
W Signature , . -( ' Title Superintendent
(over)
DOH-1555(02/2004)
GAROFALO
• (J4/) Lot No. 3A
Mdress 66 _S F WF 1 L ST . I A K E G F O R G F NY 12845 Section No.
Owner FRANK & ELIZABETH R . GAROFALO Plot ER I E
Date 9/26/06
APPROX . 67 Superficial ft. @
Location BOUNDED ON NORTH BY GAROFALO, SOUTH BY ROAD, EAST BY SULLIVAN,
WEST BY VACANT .
Corner Posts
Remarks
Deed No. (and changes) 3445
Payment Record PAID IN FULL 9/26/06 ( $1, 100 . 00)
Record of Interments
azohe -H (723. /6 t}-G ,-vim
s A
G s
4 / \, 0
s
1I I -5 //,' V
- . A,
Form No. 01
NAME GAROFALO, FRANK S.
C)LFAge: 86
Cause: Natural
Lot Owner:FRank S. & Eliza5eth R. Garofalo
Lot # 3 A Erie
Grave # 2
Case I Concrete
Died: 8/24/2013
Interred: 8/27/2013
Undertaker: Singleton
Sullivan & Potter