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Vigotty Allen Joseph
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Allen Joseph Vigotty I Male Date of Death Age If Veteran of U.S.Armed Forces, 02/24/2020 84 Years War or Dates Korean F— Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 44 Twicwood Lane, Queensbury Town, New York 12804 p Manner of Death Natural Cause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation U W Medical Certifier Name Title Anthony Petracca MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 30 ©Burial Date Cemetery,Crematory or Facility Name 03/03/2020 Pine View Cemetery Entombment Address Cremation Queensbury Town,New York Donation ZO Removal Date Place Removed and/or and/or Held ~ Hold Address N O I- Date Point of N 0 Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address El 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 or to Whom Remains are Shipped,If Other than Above Address W la Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/27/2020 Registrar of Vital Statistics Carolne zfddgarde Barger(EfectronkalySrgned) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ~ 3/3/2020 21 Quaker Rd. Queensbury NY 12804 W Date of Disposition Place of Disposition (address) W Mohican 25E 1 N (section) (lot number) (grave number) M Name of Sexton or Person in Charge of Premises Connie Goedert (lease print) Z W Signature - e Title DO H-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) u�.C1�7�. Receipt Human remains of delivered on , 20> tiJ 'Pine View Cemetary ', Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# VIGOTTY NAME AllenJoseph Vigotty Age: 84 Lot Owner: Allen & Agnes Vigotty Lot# Grave# 25E Mohican 1 Case: Concrete Died: Interred: 2/24/2020 3/3/2020 Funeral Home: Baker Cemetery: Pine View