Ranieri, Mark f(-?
NEW YORK STATE DEPARTMENT OF HEALTH ` .11•
Vital Records Section Burial - Transit Permit
pr Name First Middle Last Sex
fel Mark E. ..�.."' Ranieri Male
Date of Death Age If Veteran of U.S. Armed Forces,
rr: December 7, 2015 47 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death I XI Natural Cause I I Accident ]Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Darci Gaiotti-Grubbs MD
:: a Address
bc
102 Park Street,Glens Falls,New York 12801 _
Death Certificate Filed District Number Register Number
City, Town or Village 62 / ,5
❑Burial Date Cemetery or Crematory
❑Entombment December 9,2015 Pine View Crematorium
Address
El Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
ZZ I I Removal and/or Held
and/or Address
F Hold
N
0 Date Point of
N I I Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
1 Reinterment
Date Cemetery Address
. Permit Issued to Registration Number
� d Name of Funeral Home Regan Denny Stafford Funeral Home 01443
:; Address
,�•::: 53 Quaker Road, Queensbury,NY 12804
eName of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereb granted to dispose of the human remains described above as ' dic ted.
:::,$ Date Issued 0Registrar of Vital Statistics _ G ''.fe'i-, ti/Y 'C2r--('
};; , t (signature)
District Number �� Place
I certify that the remains of the decedent identified above were disposed of in accord ce with this permit on:
w Date of Disposition of iiir Place of Disposition 11/v (,r 1,,,,
Ill
(address)
CO
IY
(section) Ah (lot nuppber) (grave number)
Z Name of Sexton or Person in Charge of Premises r,, R/P
W
r(please print)
Signature e( _ Title �,+t
(over)
DOH-1555(02/2004)