Paolano, Frank fV for(
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Frank Joseph Paolano Male
Date of Death Age 1 If Veteran of U.S. Armed Forces,
:: April 6, 2011 82 War or Dates
Place of Death Hospital, Institution or
• City, Town or Village Queensbury Street Address 5B Manor Drive
cf Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
iIS Circumstances Investigation
Medical Certifier Name Title
' Paul F.Bachman MD
Address
3767 Main Street Warrensburg,NY 12885
▪ Death Certificate Filed District Number Register Number
City, Town or Village Queensbury 5657 3 /
❑Burial Date Cemetery or Crematory
April 8, 2011 Pine View Crematorium
❑Entombment Address
I1 Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z I I Removal and/or Held
and/or Address
F' Hold
N
O Date ' Point of
O. Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
:.:1 Permit Issued to Registration Number
:: Name of Funeral Home Singleton -Healy Funeral Home 01622
Address
• : 407 Bay Road, Queensbury, NY 12804
:: Name of Funeral Firm Making Disposition or to Whom
Its+ Remains are Shipped, If Other than Above
gl Address
lif
> ' Permission is hereby granted to dispose of the human re 'ns describe ab as indicated.
Date Issued ,N1-8,..j.. �6t Registrar of Vital Statistics
- (signature)
District Number 5657 Place Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition y-li-11 Place of Disposition f,msU `ry rie"-4t."46.-
2 (address)
W
CO
re (section) II (lot numb" (grave number)
pName of Sexton or Per n in Charge of remises ` rest N� J,,,.ao4-
Z /,Pj� 1 (please print)
W Signature G '(1+p Title Cfto,1t,0k
(over)
DOH-1555(02/2004)