Trello, Anthony It
NEW YORK STATE DEPARTMENT OF HEALTH _` 1 J
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Anthony Joseph Trello Male
Date of Death Age If Veteran of U.S. Armed Forces,
November 16, 2014 80 War or Dates
� Place of Death Hospital, Institution or
_ City, Town or Village Glens Falls Street Address Glens Falls Hospital
W- Manner of Death 0 Natural Cause ❑ Accident ❑Homicide 0 Suicide ❑ Undetermined ❑ Pending
) Circumstances Investigation
W3 Medical Certifier Name Title
13 John Stoutenburg, MD
Address
102 Park St_, G1ena Ft.11a, AY
Death Certificate Filed District Number Register Number
r City, T Glens Falls 5601
=44❑Burial Date Cemetery or Crematory
November 18, 2014 Pine View Crematorium
N.❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
and/or Address
E Hold St. Mary's Cemetery
Date Point of
'1 ❑Transportation Shipment
:: by Common Destination
Carrier
_ ❑ Disinterment Date Cemetery Address
0 Reinterment
Date Cemetery Address
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
N Remains are Shipped, If Other than Above
Address
t
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/18/2014 Registrar of Vital Statistics LA)r'AA .Q -A-1".
(signature)
<,1• District Number 5601 Place City of Glens Falls, NY
1 - I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W< Date of Disposition 11/18/2014 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
LU
1• ` (section) lot number) (grave number)
- Name of Sexton or Person in Charge of Premises /t.s dpVe_ -.... 0q041
z 4 (pleake print)
W Signature Title itat nil-PL.,
(over)
DOH-1555 (02/2004)