Profeto, Dean NEW YORK STATE DEPARTMENT OF HEATH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Dean Profeto Male
Date of Death Age If Veteran of U.S. Armed Forces,
October 26,2011 62 War or Dates
Place of Death Hospital, Institution or
iZ City, Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death X Natural Cause I Accident I I Homicide Suicide Undetermined Pending
W Circumstances Investigation
w Medical Certifier Name Title
0 Eric Pillemer
Address
CR Wood Cancer Center,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 1-1 67
❑Burial Date Cemetery or Crematory
Entombment Address
28,2011 , Pine View Crematory
Address
Ix Cremation Quaker Rd.,Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
co
O Date Point of
yTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00035
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
2 Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued t U f 2$l t I Registrar of Vital Statistics
(sign t
District Number 5601 Place Glens Falls
I—
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ILI Date of Disposition ii) 131 lit Place of Disposition R-ll)u,) ovvef d(L.
la (address)
Cl)
(section) (lot number (grave number)
pName of Sexton or Person in Ch4.__
e of Premises (tWSignature Title CQem t1
(over)
DOH-1555 (02/2004)