Gallego, Louis fi 71
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Louis V.Gallego Male
Date of Death Age If Veteran of U.S. Armed Forces,
03/06/2018 97 Years War or Dates WWII
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death Natural Cause Accident Homicide Suicide ElUndetermined ri Pending
Circumstances Investigation
' Medical Certifier Name Title
William Cleaver MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 125
❑Burial Date Cemetery or Crematory
03/12/2018 Pine View Crematory
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
Removal and/or Held
and/or Address
Hold
Date Point of
Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
CC
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/08/2018 Registrar of Vital Statistics W96ert A Curtis('ECectronicallySigned)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W. Date of Disposition 3)It tlk Place of Disposition -etv, Ls_
(address)
Cn
(section) of numbe (grave number)
Name of Sexton or Person in Charge of P emises
/7 (ple se print)
Signature (r�l Title u ,eit -
(over)
DOH-1555 (02/2004)