Zito, James NEW YORK STATE DEPARTMENT OF HEALTH 1 # 17°
Vital Records Section Burial - Transit Permit
`' Name First Middle Last Sex
James Michael Zito Male
Date of Death Age If Veteran of U.S. Armed Forces,
02/18/2018 50 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Albany Street Address Albany Medical Center Hospital
Manner of Death Natural Cause El Accident ❑Homicide El Suicide riUndetermined ri Pending
Circumstances Investigation
Medical Certifier Name Title
Mary Maskell-Amirault NP
Address —
, 43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City, Town or Village Albany 0101 0384
fr❑Burial Date Cemetery or Crematory
ZA, 02/20/2018 Pine View Crematorium
❑Entombment Address
Cremation Queensbury Town, New York
Date Place Removed
g_ ri❑Removal and/or Held
Aand/or Address
Hold
0 Date Point of
gQ Transportation Shipment
OM
ct by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
- Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Stpo Box 67,Hudson Falls,New York 12839
* Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
a Address
CC
ILI
O Permission is hereby granted to dispose of the human remains described above as Indicated.
Date Issued 02/20/2018 Registrar of Vital Statistics DanietaeS girkspie(Efec:tronicaffySigned)
(signature)
District Number 0101 Place Albany. New York
,
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition Zit1 hi Place of Disposition 1 V ' exwesiW�,
(address)
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of remises r:, J' iLi
(pi se print)
Signature a Title irEmii .
(over)
DOH-1555 (02/2004)