Celeste Jr, Patrick Ralph q 5
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Patrick Ralph Celeste Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/11/2021 66 Years War or Dates
�.. Place of Death Hospital,Institution or
WCity,Town or Village Queensbury Town Street Address 62 Mud Pond Road,Queensbury Town,New York 12804
tp Manner of Death NINatural Cause ❑Accident Homicide ❑Suicide ElUndetermined 1:1Pending
U Circumstances Investigation
III
D Medical Certifier Name Title
Robert Love MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 217
❑Burial Date Cemetery,Crematory or Facility Name
11/12/2021 Pine View Crematory
Ei Entombment Address
iCremation Queensbury Town,New York
Donation
EiRemoval Date Place Removed
and/or and/or Held
H Hold Address
0
a Date Point of
f!) 11 Transportation
p by Common Shipment
Carrier Destination
ElDisinterment 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,Queensbby,New York 12804
Name of Funeral Fir*king Disposition or to Whom
II— Remains are Ship -, C`�,�?-r than Above
2 Address
CC
Permission is heteby granted to dispose of the human remains described above as indicated.
Date Issued /12/2021 Registrar of Vital Statistics Caroline?fi[�gardeBar6er(ECectronicaQySigned)
(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:
II— �
W Date of Disposition (i 1I51 2i Place of Disposition
2 (address
W
N
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premis . '
z (ppll ea print/ / �,1 W Signature Title !� t (a�!°'��•I
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20 •
Pine View Cemetery Representing the funeral home''Qamed on burial permit
Official Funeral Directors Reg.or License#f