Catone, John 4 rr__
NEW YORK STATE DEPARTMENT OF HEALTH . 1 V
Vital Records Section Burial - Transit Permit
' Name First Middle Last Sex
John Richard Catone 1 Male
Date of Death Age I If Veteran of U.S. Armed Forces,
December 4, 2011 I 64 War or Dates f/-u L°
t,,. Place of Death Hospital, Institution or
Z City, Town or Village Warrensburg Street Address 19 Warren Street
Ati
Manner of Death XI Natural Cause ` I Accident I I Homicide 'Suicide Undetermined Pending
t1J - Circumstances Investigation
us Medical Certifier Name Title
0 Dr.John Lukaszewicz,MD
Address
s°- Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
' Ci• ty, Town or Village Warrensburg,NY �'4-6D az(
❑Burial Date Cemetery or Crematory
December 7, 2011
❑Entombment Address
CI Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z - Removal and/or Held
O - and/or Address
r." Hold
O Date Point of
N1 Transportation Shipment
a by Common Destination
Carrier _
Disinterment Date Cemetery Address
l Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan& Denny Funeral Home 01443
Address
5• 3 Quaker Road,Queensbury,NY 12804
N• ame of Funeral Firm Making Disposition or to Whom
t-, Remains are Shipped, If Other than Above
2. Address
tx
a.
Permission is hereby ranted to dispose of the human • - -in- .escribed ove as indicated.
Date Issued al Registrar of Vital Sta •= .4.,/le , /4,L--�
(signature)
.: District Number 61160 Place Warrensburg,NY
I certify that the remains of the decedent identified above were disposed of in accordancerd� with this permit on:
W Date of Disposition L ri z� Place of Disposition PPS OW C1,1,etvrkw.
W (address)
Cl)
CC (section) (lot number) (grave number)
QName of Sexton or Person in Charge of Premises �i,.:"r r Jt%Kft
Z (please print)
W
SignatureAL Title CeenycnOQ.
(over)
DOH-1555(02/2004)