Pietropaolo, JamesRM
NEW YORK STATE DEPARTMENT OF HEALTH Burial -Transit Permit
Bureau of Vital Records '
Name First Middle Last
Sex
James Pietropaolo
Male
Date of Death
Age
If Veteran of U.S. Armed Forces,
10/13/2019
87 Years
War or Dates 1955-1957
Place of Death
Hospital, Institution or
Z
City, Town or Village Saratoga Springs
Street Address Saratoga Hospital
W
Manner of Death g
❑X Natural Cause Accident Homicide 1:1Suicide Undetermined ❑ Pending
W
Circumstances Investigation
U
W
Medical Certifier Name Title
Sarah Paris MD
Address
211 Church St, Saratoga Springs, New York 12866
Death Certificate Filed
District Number
Register Number
City, Town or Village Saratoga Springs
4501
542
Burial
Date Cemetery, Crematory or Facility Name
Entombment
10/15/2019 Pine View Crematory
Address
cl Cremation
Queensbury Town, New York
Donation
ZO
Removal
Date
Place Removed
and/or Held
P
and/or
Hold Address
N
IL
Date Point of
N
0 Transportation Shipment
p
by Common
Carrier
Destination
Disinterment
Date
Cemetery Address
PReinterment
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
IM
W
n'
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/15/2019 Registrar of Vital Statistics John f'aul'Tranck(EElectronicaly( Syned�
(signature)
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Disposition
WDate
of Disposition p Place of
(address)
�
W
-j
(section) rJ lot number/ (grave number)
13
Name of Sexton or Person in Charge of Premises � t `�
/ple e print/
W
Title
Signature
DOH-1555 (07/18) p 1 of 2
Public Health Law Sec. 4145(2b)
7 1,3
'1 2^ i �
r
Receipt
Human remains of
Pine View Ci'metery
Official
delivered on
, 20
Representing the funeral home named on burial permit
Funeral Directors Reg. or License #