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Amodeo, Nicholas J. /'fig NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records •, ..- .. - Name First Middle Last Sex Nicholas J.Amodeo Male Date of Death Age If Veteran of U.S.Armed Forces, 08/05/2021 83 Years War or Dates 56-60 F Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing ILI p Manner of Death © Natural Cause ❑Accident 0 Homicide ❑Suicide ❑Undetermined ❑Pending uJ Circumstances Investigation W Medical Certifier Name Title Wendy Steinhacker PA Address 42 Gurney Ln,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 160 ElBurial Date Cemetery,Crematory or Facility Name 08/07/2021 Pine View Crematory ❑Entombment Address ElCremation Queensbury Town,New York ❑Donation Z Removal Date Place Removed and/or and/or Held _ I— Hold Address N 0 a Date Point of (/) 1-1 Transportation Shipment p by Common Carrier Destination El 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 1— Remains are Shipped,If Other than Above 2 Address CC LLJ O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/06/2021 Registrar of Vital Statistics Caroline JfiCclegarde Barber(ECectronicalTySigned) (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: h- Z Date of Disposition g rl Ili Place of Disposition ni(JL.- 444.art.L✓- tiJ 2 (address) W CCCC (section) /f (lot number) (grave number) S Name of Sexton or Person in Charge of Premis f' L I Z ii (p ase print) alaifitet Signature (..) Title f "M DOH-1555(07/18)p 1 of 2 315015 Public Health Law Sec. 4145(2b) Receipt Human remains of r',.4I i/i 1,1,r0 delivered on '``,/) , 20 `( i Pine View Cemetery Representing the flute al home named on burial permit Official Funeral Directors Reg.or License#i''t_ i 3 f1