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Pastroro NEW YORK STATE DEPARTMENT OF HEALTH Burial - TransitPermit Vital Records Section Name First Middle Last Sex Frank A. Pastroro Male gDate of Death Age If Veteran of U.S. Armed Forces, February 6, 2011 65 War or Dates ' Place of Death Hospital, Institution or .1 City, Town or Village Glens Falls Street Address Glens Falls Hos•ital '' Manner of Death❑ ❑ I I n ❑ Undetermined ❑ Pending X Natural Cause Accident Homicide Suicide Iv Circumstances Investigation 1...z, Medical Certifier Name Title ,i Villa Fuerte, M.D 7 Address rA af 200 Smith Street Corinth, NY 12822 Death Certificate Filed District Number /,-� I+ Register Numl�r I City, Town or Village l� ❑Burial Date Cemetery or Crematory February 8, 2011 Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed ❑ Removal and/or Held and/or Address l Hold Pine View Crematorium Date Point of ❑Transportation Shipment by Common Destination Carrier Att ❑ Disinterment Date Cemetery Address g `,❑ Reinterment Date Cemetery Address CI M . Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00276 Address z Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 .< Name of Funeral Firm Making Disposition or to Whom '' Remains are Shipped, If Other than Above Address Permission is hereby ranted to dispose of the human remains descri ab ve m Date Issued Or // Registrar of Vital Statistics G U-. s (signature) District Number .-O/ Place7.els.o /77 , / I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 02/08/2011 Place of Disposition Quaker Road Queensbury,NY 12804 ,,, (address) (section) (lot number) ,# (grave number) g. a Name of Sexton or Person in Charemises r»to Qhr. `-'tin^itt (please print) s a11 Signature Title CRZM►Tt Of_,, (over) DOH-1555 (02/2004)