Vollaro, Alida NEW YORK STATE DEPARTMENT OF HEALTH J 0
Vital Records Section t . . Burial - Transit Permit
Name First Middle Last Sex
Alida J. Vollaro Female
Date of Death Age If Veteran of U.S. Armed Forces,
January 19, 2013 84 War or Dates No
f. Place of Death Hospital, Institution or
Z City, Town or Village Queensbury Street Address Stanton Nursing& Rehab Centre
W Manner of Death
W X Natural Cause n Accident I I Homicide n Suicide n Undetermined Pending
Circumstances Investigation
w Medical Certifier Name Title
G Roslyn Socolof Dr.
Address
42 Gurney Lane,Queensbury,NY 12804
Death Certificate Filed District Number Regier Number
City, Town or Village Queensbury 5657 r l!
❑Burial Date Cemetery or Crematory
❑Entombment January 25, 2013 Pine View Crematorium
Address
I1 Cremation 21 Quaker Road, Queensbury, NY 12804
Date Place Removed
ZZ n Removal and/or Held
and/or Address
H Hold
N
0 Date Point of
U Transportation Shipment
p by Common Destination
_ Carrier
n Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
t Address
W
Permission
{is hereby granted to dispose of the human remains described above as indicated.
Date Issued \ I2 123 Registrar of Vital Statistics ' \-\�
(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:
f�
W �Date of Disposition (-is-13 Place of Disposition aUzia
W (address)
Cl)
CL (section) (lot number (grave number)
QName of Sexton or Person in Charge of remises
Z / please print)
W Signature G LL Title CQEA+rtioe..
(over)
DOH-1555(02/2004)