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Altizio, Christopher YORK STATE DEPARTMENT OF HEALTH �� Records Section Burial - Transit Permit Name First Middle Last Sex Christopher Altizio Male Date of Death Age If Veteran of U.S. Armed Forces, February 25, 2016 57 War or Dates ZPlace of Death Hospital, Institution or City, Town or Village Hudson Falls Street Address 2323 Burgoyne Ave WW Manner of Death 0 Natural Cause ElAccident ElHomicide ElSuicide ❑ Undetermined ri❑ Pending Circumstances Investigation W Medical Certifier Name Title CI ZAN), L u rAsz ey,a i ez Address gq 6roca s1 Ciehs arts AP4 i Zsoi Death Certificate Filed District Number Register Number City, Town or Village 5-7 U. 7 ❑Burial Date Cemetery or Crematory February 29, 2016 Pine Vew Crematorium ❑Entombment Address ©Cremation Queensbury,NY 12804 Date Place Removed EllRemoval and/or Held and/or Address Hold i Date Point of eL ❑Transportation Shipment CI) by Common Destination C3 Carrier Date Cemetery Address El Disinterment Date Cemetery Address ❑ Reinterment Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom t— Remains are Shipped, If Other than Above 2 Address t W O. Permission is hereby granted to dispose of the human re ' s c.e ribed above as indicated. Date Issued a jai�k!� Registrar of Vital Statistics � �� ,Q (signature) District Number $-1 Place v. _L Te 00 n I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: iii Date of Disposition 02/29/2016 Place of Disposition Prti tilt' C otf o7LUI'n 2 (address) W' CO Ce (section) �l/ (lot number) (grave number) pName of Sexton or Person in Charge of Premises l hro-tcr.� mit- It 1-01,4* (p/base print) W; Signature Title alkilgt (over) DOH-1555 (02/2004)