Pellino Sr., Louis Anthony 41-55
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Louis Anthony Pellino Sr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/16/2021 88 Years War or Dates 1952-1956
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation
W Manner of Death
o Natural Cause Accident Homicide 0 Suicide ElUndetermined El Pending
W C.) Circumstances Investigation
W Medical Certifier Name Title
C Courtney Diamond NP
Address
170 Warren St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 297
ElBurial Date Cemetery,Crematory or Facility Name
07/22/2021 Pine View Crematory
EiEntombment Address
0 Cremation Queensbury Town,New York
❑Donation
ZO 0 Removal Date Place Removed
and/or and/or Held
F Hold Address
0
Ct. Date Point of
U) ❑Transportation Shipment
Q by Common
Carrier Destination
Ei
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
1— Remains are Shipped,If Other than Above
2 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/19/2021 Registrar of Vital Statistics RPhirt Andrew Curtis.gkaroaicallySigne)
(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:
WDate of Disposition 71731 14 Place of Disposition s t V►.- G <
2 (address)
W
CC (section) (lot number ,� (grave number)
SName of Sexton or Person in Charge of Pre i s Art ti �'' �V I
Z L^/` f (Plea eprint)
W Signature /fL Title (04kelt kl°C
DOH-1555(07/18)pi of 2
• ' 149R V;
Public Health Law Sec. 4145(2b) `'
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home-named on burial permit
Official Funeral Directors Reg.or License#