Quagliana Jr., Lucia Nunzio NEW YORKSTATE DEPARTMENT OF HEALTH 114Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Luca Nunzio Quagliana Jr. Male
Date of Death Age If Veteran of U.S.A
07/29/2021 30 Years War or Dates Afg
Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death ❑Natural Cause El Accident Homicide XI Suicide ❑Undetermined ❑Pending
LL! Circumstances Investigation
pW Medical Certifier Name Title
Timothy Murphy Coroner
Address
52 Haviland Avenue,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 316
❑Burial Date Cemetery,Crematory or Name
08/02/2021 Pine View Crematory
❑Entombment Address
0 Cremation Queensbury Town,New York
▪Donation
ORemoval Date Place Removed
and/or and/or Held
Hold Address
0
N ❑Transportation Date Point of
5by Common Shipment
Carrier Destination
•
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
E- Remains are Shipped,If Other than Above
Address
CC
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/30/2021 Registrar of Vital Statistics 24,6ertAndrew 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:
Z. Date of Disposition brl If I if Place of Disposition .+i.;`L,
2 (address)
W
cc (section) �rrpot limber) (grave number)
Name of Sexton or Person in Charge o remises h rt t c�tM+tilt
W � (please rint/ /�
Signature vC r Title Ir 'iirm
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) 014 9 96
Receipt
Human remains of - delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#