Pozzuoli, John tt (6q
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
• Name First Middle Last Sex
John F. Pozzuoli Male
Date of Death Age If Veteran of U.S. Armed Forces,
February 17, 2011 95 War or Dates World War II
i`�` Place of Death Hospital, Institution or
tis° City, Town or Village Queensbury Street Address Stanton Nursing& Rehab Centre
ci Manner of Death I Natural Cause [ I Accident Homicide Suicide 'Undetermined Pending
ti Circumstances Investigation
Medical Certifier Name Title
.. Roslyn Socolof,MD
Address
▪ Sherman Ave,Queensbury,NY
Death Certificate Filed District Number FIeg�ster Number
• City, Town or Village Queensbury,NY 5657 I S
❑Burial Date Cemetery or Crematory
February 21,2011 St.Mary's Cemetery
❑Entombment Address
El Cremation Main Street, South Glens Falls,NY 12803
Date Place Removed
Z I I Removal and/or Held
and/or Address
F' Hold
N
O Date Point of
Nn Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
ri
Reinterment Date Cemetery Address
Permit Issued to Registration Number
:i• ;. Name of Funeral Home Singleton-Healy Funeral Home 01622
Address
407 Bay Road,Queensbury, NY 12804
i„;e] Name of Funeral Firm Making Disposition or to Whom
Ia*+ Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human?*emains descri d above as indicated.
_• x.' )la-D-la Registrar Issued 6� Re istrar of Vital Statistics ''
(signature)
District Number 5657 Place Queensbury,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition Fe15 'Z�y Place of Disposition ?ilnt iL _ Cto► t o civ�
W (address)
U)
re (section) i (lot number} (grave number)
Q Name of Sexton or Person in Charge f Premises (�i r,si ur^ Jo nriti-
W /f i (please print)
Signature (/ Title f't2F�, r
(over)
DOH-1555(02/2004)