Raspante, Patrick NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
s Name First Middle Last ' Sex
rrr: Patrick Jude Raspante Male
:
r Date of Death Age If Veteran of U.S. Armed Forces,
• 0 October 1 2015 59 War or Dates n/a
� Place of Death
I Hospital, Institution or
City, Town or Village Glens Falls,NY Street Address Glens Falls Hospital
Manner of Death X Natural Cause I Accident Homicide [ Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
r ,. r� Address I
::::::: C ---)C'"C ni
r ; Death Certificate Filed District Number Register N�r�llgr
.:. City, Town or Village Glens Falls,NY 5601 y�l�/
= EI Burial Date Cemetery or Crematory
October 5, 2015 Pine View Cemetery
❑Entombment Address
❑Cremation Quaker Road, Queensbury, NY 12804 _
Date Place Removed
Z I I Removal and/or Held
9. and/or Address
F- Hold
0 Date Point of
N I I Transportation Shipment
a by Common Destination
Carrier
I I Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
;, Registration Number
®�� Permit Issued to
;:r;:; Name of Funeral Home Regan Denny Stafford Funeral Home 01443
°3 Address
rr • 53 Quaker Road, Queensbury,NY 12804
v-7 Name of Funeral Firm Making Disposition or to Whom
11 Remains are Shipped, If Other than Above
Address
:Y.icii Permission is hereby granted to dispose of the human remains described above as indicated.
'? Date Issued i 0/5 / 15 Registrar of Vital Statistics (i1/4.;r .y.-yam W-1.
"r- (sign ture)
,x::: District Number 5 6o 1 Place 6 j qi `l S ) ii y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
tu Date of Disposition 1 0/5/1 5 Place of Disposition Pine View Cemetery, Queensbury, NY
2 (address)
w Erie 83C 1
KZ (section) (lot number) (grave number)
QName of Sexton or Person in Charge of Pre • es Connie L. Goedert
Z e17-7t4et;
(please print)
toSignature r .,2 Title Cemetery Superintendent
(over)
DOH-1555(02/2004)