Giovanni, paul J. _ -k 417
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Paul J.Giovanni Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/28/2020 98 Years War or Dates 1943-1946
F. Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation
W W Manner of Death Undetermined Pending
�Natural Cause �Accident �Homicide �Suicide
Circumstances Investigation
WMedical Certifier Name Title
Jean Flanagan MD
Address
170 Warren St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 192
Burial Date Cemetery,Crematory or Facility Name
04/30/2020 Pine View Crematory
Entombment Address
11-1
Cremation Queensbury Town,New York
❑Donation
z Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
O
0• Date Point of
to Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition orto Whom
IF— Remains are Shipped,If Other than Above
M Address
Ix
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/29/2020 Registrar of Vital Statistics �Wea,4NdrewC4(rtzr(ElecmotikalfySir=4
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition I2 1, 9-�zr) Place of Disposition
Uj (address)
W
It (section) (! umber/ (grave number)
Name of Sexton or Person in a Pr ises �"s '�
Z p/ease print) f
Uj Signature Title
DO H-1555(o7/18)p 1 of 2
Public Health Law Sec. 4145(2b) ??
Receipt
Human remains of delivered on =}, 20
i
Pine View Cemetery Representing the funeral home named on burial.permit
Official Funeral Directors Reg.or License#