Parisi, Rymond NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Raymond Nicholas Parisi Male
Date of Death Age If Veteran of U.S. Armed Forces,
September 1,2013 30 War or Dates
f., Place of Death Hospital, Institution or
Z City, Town or Village Queensbury Street Address 33 Honeysuckle Lane
p Manner of Death Natural Cause Accident Homicide Suicide Undetermined D Pending
Circumstances Investigation
G Medical Certifier Name Title /
Paul Bachman C Grogr
Address
Death Certificate Filed District Number Register rNNumber
City,Town or Village Queensbury 5657
❑Burial Date Cemetery or Crematory
Entombment September 4, 2013 Pine View Crematory
Address
®Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
ZO ri Removal and/or Held
and/or Address
Hold
O Date Point of
N Ei Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
Address
W
0. Permission is hereby granted to dispose of the human em "ns described abov -a indicated.
Date Issued? It 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:
ui Date of Disposition 11 t11i3 Place of Disposition ,t9a,,,J 6,4/�,.
LU (address)
(section) (lot number) (grave number)
Q Name of Sexton or Person i Charge of Premises L �QI
,�
W (pl ase print)
Signature Title CIZE-fin
(over)
DOH-1555(02/2004)