Puglisi, George 08/15/2017 08:32 5183773446 LIGHTS FUNERAL HOME PAGE 02/02
NEW YORK STATE DEPARTMENT OF HEALTH Burial N Transit Permit
Vital Records Section
{..:: Name First Middle Last Sex
GEORGE S. PUGLISI MALE
,. Date of Death Age If Veteran oft U.S.Armed Forces,
08/09/2017 76 '
1962-86
' Place of Death Hospital,Institution
City,Town or village City of Albany or Street Address ALBANY MEDICAL CTR. HOSPITAL
Manner of Death Natural ❑ Undetermined ❑ Fending
❑ Cause Accident ❑ Homicide Suicide Circumstances Investigati
❑ la Suicide
eta. Medical Certifier Name Title
c' JOHN KEEGAN CORONER
Address ..
:' 112 STATE STREET, ALBANY, NY 12207
,' f Death Certificate Filed - District Number Register Number
,
City,Town or Village City of Albany _ 101 1730 _
El Burial Date Cemetery or Crematory
El Entombment 08/16/2017 PINE VIEW CREMATORIUM
• ®Cremation Address
51 QUAKER ROAD, QUEENSBURY, NY 12804 _
Date Place Removed
+� Removal and/or Held
2 ❑ and/or Address
'1•.. Hold
Date Point of
p, Transportation Shipment
th. ❑ By Common Destination
p Carder
Date
Cemetery Address
❑ Disinterment D Date Cemetery Address
❑ Reinterment
Y 'Permit Issued To Registration Number
tt-; Name of Funeral Home REGAN DENNY STAFFORD FUNERAL HOME 01443
Address
53 QUAKER ROAD, QUEENSBURY, NY 12804
Name of Funeral Firm Making Disposition or to Whom
i Remains are Shipped,If Other than Above
Address
litt
Ifit1
Permission is hereby granted to dispose of the human remains descri ove as indicated.
r`4, Date 08/14/2017 r6g,
Issued Registrar of Vital Statistics
(sign ure)
District Number 101 Place City of Albany, NY
P
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
a /
Date of Disposition S!flll Place of Disposition 'I,nrVs" icm+ararf�
ui (address)
'W
co
0 (section) of number) (grave number)
:W Name of Sexton or Person in Charge of Premises / s
(please print)
I Signature t .tb' Title +f 1 CCfPJA�L
(over)
DOH-1555(02/2004)