Viola, Angelo Joseph # 566
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records •
Name First Middle Last Sex
Angelo Joseph Viola Male
Date of Death Age If Veteran of U.S.Armed Forces,
06/17/2021 90 Years War or Dates Navy
l~ Place of Death Hospital,Institution or
W City,Town or Village Queensbury Town Street Address 57 Surrey Field Drive,Queensbury Town,New York 12804
p Manner of Death g Natural Cause ❑Accident ❑Homicide 0 Suicide Undetermined ❑Pending
W U Circumstances Investigation
W Medical Certifier Name Title
O Aimee Mcmaster Nurse Practitioner,Acute Care
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 126
ElBurial Date Cemetery,Crematory or Facility Name
06/21/2021 Pine View Crematory
EiEntombment Address
0 Cremation Queensbury Town,New York
ElDonation
ZO EI Removal Date Place Removed
and/or and/or Held
F- Hold Address
N
0
d Date Point of
t/) Li Transportation Shipment
p by Common
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
F— Remains are Shipped,If Other than Above
5 Address
CIC
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/21/2021 Registrar of Vital Statistics CarainexldegaraeBar6er(' ctrvnical61Signe4
(signature)
District Number 5657 Place Queensbury, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
~
Z Date of Disposition (Pill I/ Place of Disposition �µ�` d(r`
w2 (address)
W
CoCC (section) (lot number) (grave number)
0 ,of Sexton or Person in Charge of P mises r �"t'uN
Z L (p1 se print/
IllSi nature /�
g Title G C04 Ian
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) J0 1_4 874
Receipt
{
Human remains of - delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
1