Loading...
D'Alessandro, David NEW YORK STATE DEPARTMENT OF HEALTH `` l773 Vital Records Section Burial - Transit Permit ` Name First Middle Last Sex -' David Allen D'Alessandro Male Date of Death Age If Veteran of U.S. Armed Forces, ` i 02/20/2018 76 Years War or Dates I Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause El Accident El Homicide El Suicide ElUndetermined Pending Circumstances Investigation Medical Certifier Name Title Shahid Ahmed MD Address 100 Park St,Glens Falls,New York 12801 Z'\ Death Certificate Filed District Number Register Number F City, Town or Village Glens Falls 5601 98 F ❑Burial Date Cemetery or Crematory 02/21/2018 Pine View Crematory ❑Entombment Address ®Cremation Queensbury,NY Date Place Removed Removal and/or Held and/or Address Hold Date Point of Q Transportation Shipment by Common Destination Carrier Date Cemetery Address 5 Q Disinterment 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 Mho Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby g ranted to dispose of the human remains described above as indicated. Date Issued 02/21/2018 Registrar of Vital Statistics R06ertA Curtis(E(ectronicat&Signed) (signature) :, District Number 5601 Place Glens Falls, New York t I I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition ii t2lff Place of Disposition .P.. L i -i .. (address) (section) (lot number)(�__-- (grave number) Name of Sexton or Person in Charge of remises d , ( lease print) ri '4 Signature Gi Title (1*.toh - (over) DOH-1555 (02/2004)