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Carnevale, Louis NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Louis F.Carnevale I Male Date of Death Age If Veteran of U.S.Armed Forces, 05/16/2020 65 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital Uj p Manner of Death ❑c Natural Cause Accident Homicide ❑Suicide Undetermined Pending tu Circumstances Investigation WMedical Certifier Name Title Asim Chaudry MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 221 Cemetery,Crematory or Facility Name 05/21/2020 Pine View Cemetery ©Burial Date Entombment Address Cremation Queensbury Town,New York Donation Z ❑Removal Date Place Removed O and/or and/or Held ~ Hold Address N d Date Point of N a Transportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address JE]Reinterment Date Cemetery Address Registration Number Permit Issued to 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 Remains are Shipped,If Other than Above Address IX lu a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/19/2020 Registrar of Vital Statistics Rj96ert,4n rewC.,tir(Electronicad Srgned) (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: ~ Place of Disposition ueens W Date of Disposition 5 21 2 0 2 0 p (address)- 2 W Erie N (section) (lot number) (grave number) Ix 8 Name of Sexton or erson in Charge of Premises CONNIE / (please print/Z llu Signature _ e Title Superintendent DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of -w delivered on , 20 > Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# CARNEVALE NAME LOUIS CARNEVALE Age: 65 Lot Owner: NANCY CARNEVALE Lot# Grave# ERIE 24 C 1 Case: CONCRETE �e Died: inter IntM 6/2020 1 /2020 Funeral Home: Singleton, Sullivan, Potter Cemetery: Pine View