Cottone, Alfonso NEW YORK STATE DEPARTMENT OF HEALTH if 7Z t Vital Records Section Burial - Transit Permit
.. Name First Middle Last Sex
Alfonso F. Cottone Male
Date of Death Age If Veteran of U.S. Armed Forces,
October 2,2016 86 War or Dates 1947- 1950
Place of Death Hospital, Institution or
7i City, Town or Village Queensbury Street Address Stanton Nursing& Rehab Centre
Manner of Death X Natural Cause Accident ❑Homicide [Suicide 1 I Undetermined n Pending
Circumstances Investigation
€ Medical Certifier Name Title
Roslyn Socolof Dr.
Address
Stanton NH, 152 Sherman Ave,Glens Falls,NY 12804
• Death Certificate Filed District Number Register Number
City, Town or Village Queensbury 5657 1z t
❑Burial Date Cemetery or Crematory
October 4, 2016 Pine View Crematorium
❑Entombment Address
❑x Cremation 51 Quaker Road,Queensbury,NY 12804
Date Place Removed
ZZ n Removal and/or Held
2 and/or Address
Hold
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0 Date Point of
n Transportation Shipment
p by Common Destination
Carrier
n Disinterment Date Cemetery Address
Date Cemetery Address
(-7 Renterment
Permit Issued to Registration Number
Name of Funeral Home Re an Denn Stafford Funeral Home 01443
f Address
53 uaker Road, ueensbur ,NY 12804
Name of Funeral Firm Making Disposition or to Whom
r Remains are Shipped, If Other than Above
Address
Permission is here y granted to dispose of the human re ains describedbe abo ,as indicated.
Date Issued 1. L(, Registrar of Vital Statistics t �--{
(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:
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u.l Date of Disposition 1/4-7-4, Place of Disposition p1-71(2_i)R .1,-,2-m f
2 (address)
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N 0 (section) 3 gpt'number) (grave number)
0p Name of Sexton or P so 'n Charge of Premises i.�./rin,✓1 t/9a-W/ �z.
ice
Z 4 �� `r (please print)
W Signature Title �./21-r7 T
(over)
DOH-1555(02/2004)