Pettinelli, Fred NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section .
,iii Name First Middle Last Sex
tip`: Fred J• Pettinelli Male
,
&s`x
l Date of Death Age If Veteran of U.S.Armed Forces,
12 / 05/ 2017 86 War or Dates .•
lace oDea- Hospital, Institution or
City,Town or Village Albany Street Address Albany Medical. Center
Manner of Death®Natural Cause ❑Accident Ei Homicide 0 Suicide Ej Undetermined ri IPending
Circumstances nvestigation
g Medical Certifier Name _ Tie
Deal Oaf aro NV
Address
i: •,
k*: 43 New Scotland Ave Albany, NY 12200
40
ati Death Certificate Filed District Number Regillf4umber
City,Town or Visage Albany
45urial Date Cemetery or Crematory.
A',.:;- 12 / 07/ 2017 • Pine View Crematory
}®Entombment Address
ita BCremation _ Queeusbury, KY
Date Place Removed
Q Removal - and/or Held
and/or Address
Hold
Date Point of
0 Transportation Shipment
by Common Destination
Carrier
`[]Disinterment Date Cemetery Address
[-1 Reinterment
Date Cemetery Address
0 Permit issued to Registration Number
1k} Name of Funeral Home Compassionate Funeral Care 00364
t„: Address .
402 Maple Ave., Saratoga sp., NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
M
Permission 1s hereby granted to dispose of the human remai de b indicated.
El Date Issued 17 /7Jfl Registrar of Vital Statistics � ��
r: (signature) .
District Number 0 Place Aibaay , New York
iii. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I Date of Disposition t Place of Disposition T p r
(address)
(section) A(lot number) (grave number)
• Name of Sexton or Person ip Charge of Pram' f:� ' _crr�f
(P se PrelU
Signature �i Title 6161ti} l
(over)
DOH-1555(02/2004)