Puglisi, Dennis hIbd?
NEW YORK STATE DEPARTMENT OF HEIM
Vital Records Section Burial - Transit Permit
`off Name First Middle Last Sex
' Dennis J. Puglisi Male
VP, Date of Death Age If Veteran of U.S. Armed Forces,
August 9, 2017 71 War or Dates
gi;, Place of Death Hospital, Institution or
aCity, Town or Village Johnsburg Street Address 802 South Johnsburg Rd.
Manner of Death ! Natural Cause n Accident X Homicide n Suicide n Undetermined n Pending
Circumstances Investigation
Medical Certifier Name Title
11 Terry M. Comeau,Coroner
Address
f
:,,,Ai 1340 State Rt.9,Lake George NY
`± . Death Certificate Filed District Number Register umber
. f:
City, Town or Village Johnsburg SO-S S l 7
❑Burial Date Cemetery or Crematory
August 15, 2017 Pine View Crematory
❑Entombment Address
CI Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed ) ,o'
ZZ n Removal and/or Held
and/or Address
F' Hold
CO
0 Date Point of
Nn Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address 0
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
p,
53 Quaker Road, Queensbury, NY 12804
f Name of Funeral Firm Making Disposition or to Whom
iRemains are Shipped, If Other than Above
.
Address
.,.? Permission is hereby granted to dispose of the human ins descr'bed ab s indicated.
z Date Issued S" IL ` / Registrar of Vital Statistics
(signature)
'`,;:. District Numbers 6 5S Place Johnsburg
j.J
�f rig
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition Q 1I b'n Place of Disposition Flu v'NJ (*rrnat 0 ra.....
2 (address)
W
CO
OC (section) ro Qt number) (grave number)
ap Name of Sexton or Person in Charge of remises ti n 3 ail 1
Z (ple4se print)
W
Signature Zit 0Nle Title l lotl ae.-
(over)
DOH-1555(02/2004)