Iannucci, James '�
NEW YORK STATE DEPARTMENT OF HEALTH f 1 # 7g%
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
• James G. Iannucci Male
Date of Death Age If Veteran of U.S. Armed Forces,
,. December 19,2013 51 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospitali Manner of Death Undetermined Pending
�+ �Natural Cause Accident _ Homicide Suicide
Circumstances Investigation
in; Medical Certifier Name Title
a, Dr.William Borgos
Address
14 Manor Drive,Queensbury,NY 12804
Death Certificate Filed District Number Register Number
.:.%1 City, Town or Village Glens Falls 5601 SS 3
❑Burial Date Cemetery or Crematory
❑Entombment December 23,2013 Pine View Crematory
Address
0 Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
U)
O -
Date Point of
NTransportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
fPermit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg, NY 12885
Name of Funeral Firm Making Disposition or to Whom
1 Remains are Shipped, If Other than Above
Address
Ati
It;, Permission is hereby grantedto dispose of the human remains described above as indicated.
: ' ' Date Issued 12/2 3! i 3 Registrar of Vital Statistics 1/0 .&'�Q Ct ., w `
(signatu e
1 District Number 5601 Place 5601. 6 (9.„.S `\Sr N
H
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
w Date of Disposition p-at,- 3 Place of Disposition �, w (0 ,
(address)
W
CO
CL (section) got nu ber) (grave number)
QName of Sexton or Person in Charge Premises r,i 3aAA.t
Z dpil.._
(pleas print)
WSignatureTitle Cr
(over)
DOH-1555 (02/2004)