Pellino, Joel Ryan NEW YORKSTATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Joel Ryan Pellino Male
Date of Death Age �If�Veteran of U.S.Armed Forces,
11/07/2019 33 YearsDates
t— Place of Death Hospital,Institution or
LLJ
Z City,Town or Village Albany Street Address Albany Medical Center Hospital
U Manner of Death 0 Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
UJ Medical Certifier Name Title
Tara Fitzgerald NP
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 2396
Burial Date Cemetery,Crematory or Facility Name
11/13/2019 Pine View Crematory
Entombment Address
Cremation Queensbury,New York
Donation
0 Removal Date F
e Removed
and/or or Held
~ Hold Address
N
O
a Date Point of
U)❑Transportation
p by Common Shipment
Carrier Destination
❑Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition orto Whom
Remains are Shipped,If Other than Above
Address
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/12/2019 Registrar of Vital Statistics Dante&Sgiaesrpre(EYectronkallySigneQJ
(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:
H p
Z Date of Disposition /111,J115 Place of Disposition
tu
2 (address)
uJ.
Q (sedion) (lot number) (grave number)
GName of Sexton or Person in Charge of Premises o �' Vt
Wlease print)
Signature �,� .r— Title Ac Tak
DOH-1555(07/18)p 1 of 2
-77
Public Health Law Sec. 4145(2b) )13 0
Receipt
Human remains of t delivered on , 20
Pine View Cemetery Represenfing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
t