The URL can be used to link to this page

Chiovoloni, Nicholas Mitchell t0 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Nicholas Mitchell Chiovoloni Male Date of Death Age If Veteran of U.S.Armed Forces, 01/13/2020 19 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Albany Street Address Albany Medical Center Hospital p Manner of Death ❑Natural Cause Accident Homicide ❑Suicide Undetermined ©Pending W Circumstances Investigation 1!J Medical Certifier Name Title D Paul Marra Coroner Address 112 State Street,Albany,New York 12207 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 0097 ❑Burial Date Cemetery,Crematory or Facility Name 01/18/2020 Pine View Crematory Entombment Address Cremation Queensbury,New York Donation Z ❑Removal Date Place Removed and/or and/or Held _ ~ Hold Address O IL Date Point of ❑Transportation Shipment Carrier S by Common Destination Disinterment Date Cemetery Address I Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom IF- Remains are Shipped,If Other than Above 2 Address W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/15/2020 Registrar of Vital Statistics (Danieffe S Gii7espie(ECectronically Signed /signature/ I District Number 0101 Place Albany, New York j I I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition Zl 10 Place of Disposition ' I r ` W (address) W (sectW (/otnumber) (gravenumber/ j Name of Sexton or Person in Charge of Premises ' 801#Seprin-V W Signature Title j I DOH-1555(07/18)p 1 of 2 I I I Or Public Health Law Sec. 4145(2b) 1 Receipt Human remains of _ delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#