Siletti, Peter Joseph 151-6
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Peter Joseph Siletti Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/17/2020 76 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
`p Manner of Death al Natural Cause l=1 Accident Homicide 1:1Suicide ❑Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
CI 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 579
❑Burial Date Cemetery,Crematory or Facility Name
12/21/2020 Pine View Crematory
Entombment Address
0 Cremation Queensbury Town,New York
ElDonation
o ElRemoval Date Place Removed
and/or and/or Held
i- Hold Address
0
IL Date Point of
U) U Transportation
p by Common Shipment
Carrier Destination
❑Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
E. Remains are Shipped,If Other than Above
2 Address
CC
• Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/18/2020 Registrar of Vital Statistics $',o6ert./Inrfretu Curtis(EYectronica15iSigned)
(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:
2
W Date of Disposition /2-22.?fi?Zi) Place of Disposition (L)�...,44) 2?� ynde'��
2 (address) /
W
CC
N (section) if (lot number) (grave number)
0 Name of Sexton or Person i arge Premises �`'�'� �G�
Z (please print)
W Signature Title C 2e-m 0 er
DOH-1555(07/18)p 1 of 2 /
i
1 I
j _
Public Health Law Sec. 4145(2b) 01.4 31
Receipt
i Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#