Filippelli, Gabriel 0 ", (j
NEW YORK STATE DEPARTMENT OF HEALTH 7��
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Gabriel John Filippelli Male
Date of Death Age If Veteran of U.S.Armed Forces,
06/07/2018 85 Years War or Dates
1- Place of Death Hospital, Institution or
i City, Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death X❑Natural Cause ❑Accident El Homicide El Suicide ❑Undetermined ❑Pending
IU
Circumstances Investigation
Medical Certifier Name Title
0 Suzanne Rayeski DO
'{ Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 286
❑Burial Date Cemetery or Crematory
06/12/2018 Pine View Crematory
['Entombment Address
®Cremation Queensbury, New York
I Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
C by Common Destination
_1 Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
fr
Q" Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/11/2018 Registrar of Vital Statistics Rp6ertA Curtis(ECectronicaffySigned)
(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:
InDate of Disposition Wei Ij8 Place of Disposition c.d./ � •.�,.,,
t.l (address)
Cl)
to (section) (lot number) (grave number)
pName of Sexton or Person in Charge of Premises �rji it ' 3' '
zdi (please print)
W' Signature Title (t2 i TiX -
(over)
DOH-1555(02/2004)