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Scallero Jr, Gregory
NEW YORK STATE DEPARTMENT OF HEALTH .3`' ' Vital Records Section ` . -A Burial - Transit Permit ii Name First Middle Last Sex Gregory John Scallero, Jr. Male [ Date of Death Age If Veteran of U.S. Armed Forces, gi May 26, 2_01 3 79 War or Dates Korean Conflict $4 Place of Death Hospital, Institution or z City, Town or Village Glens Falls Street Address Glens Falls Hospital 1 Manner of Death ❑x Natural Cause 0 Accident n Homicide ❑Suicide 0 Undetermined El❑Pending Circumstances Investigation Medical Certifier Name Title 1 Eric Pillemer MD. Address Glens Falls Wospita-_ Glens Fa11G, NY 12801 €i: Death Certificate Filed District Number Register Number Mi City, Town or Village Glens Falls 5601 -22-G Date Cemeter or Crematory ❑Burial May 28, 2013 PyineView Crematorium Address ©Cremation Town of Queensbury, NY. 12804 FDate Place Removed 0 ❑Removal and/or Held .r and/or Address O Hold Q Date Point of NQ Transportation Shipment a by Common • Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Mason Funeral Home Registration Number iNiName of Funeral Home 01 1 1 7 Address P.O. Box 277, 18 George St,Fort Ann, NY. 12827 '`_'' Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above idl Address • isPermission is hereby granted to dispose of the human remains described above Y s i ted. Date Issued May 28, 20113egistrar of Vital Statistics Mil (signature iiiiiiii District Number 5601 Place City of Glens Falls, NY. 12801 I certify that the remains of the decedent identified above were disposed of in ordance with this permit on: f- W Date of Disposition 5/A I13 Place of Disposition 4tL, Creb iiri►..._ „Z (address) LU N C (section) A(Io.nJmber) ( rave number) Name of Sexton or Perso in Charge of Pr mises - �g+) z ) (please print) LU Signature (01(�._ Title � AT�r�° (over) DOH-1555 (9/98)