Garuccio, Andrew NEW YORK STATE DEPARTMENT OF HEALTH if - I, �1
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
'rr�, Andrew F. Garuccio Male
f Date of Death Age If Veteran of U.S. Armed Forces,
May 6, 2013 69 War or Dates
Place of Death Hospital, Institution or
'I City, Town or Village Queensbury Street Address 8 Old Forge Road
Ut
Manner of Death j Natural Cause ❑Accident ❑Homicide n Suicide Undetermined Pending
Circumstances Investigation
iMedical Certifier Name Title
1' Robert Reeves,MD
Address
3 Irongate Center,Glens Falls,NY 12801
i..::<:;: Death Certificate Filed District Number Register Number
City, Town or Village Queensbury,NY 5657 (O /
El Burial Date Cemetery or Crematory
May 8, 2013 Pine View Crematory
❑Entombment Address
❑X Cremation Quaker Road, Queensbury, NY
Date Place Removed
OZ ❑Removal and/or Held
and/or Address
F" Hold
W
O Date Point of
u) Transportation Shipment
p by Common Destination
Carrier
❑Disinterment Date Cemetery Address
El Reinterment Date Cemetery Address
.'::: Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
{ r Address
53 Quaker Road, Queensbury,NY 12804
r Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby g dispose to dis ose of the human re ins described ab as indicated.
Date Issued 5- 9 —, 6‘.3 Registrar of Vital Statistics
(sIgnatur
District Number 5657 Place Queensbury,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
C
ill Date of Disposition �-�-0 Place of Disposition F irJ +✓
W (address)
Cl)
re (section) (lot mber) (grave number)
pName of Sexton or Perso in Charge of Premises hr�s �Q '
IZ (pl se print)
Signature Title Ci iww}('�Q`
(over)
DOH-1555(02/2004)