Vitro, Gary Thomas it 66
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Gary Thomas Vitro Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/10/2021 67 Years War or Dates
i.., Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
LU
p Manner of Death 0Natural Cause ❑Accident ❑Homicide ❑Suicide L jUndetermined Pending
LLI
U Circumstances Investigation
W Medical Certifier Name Title
CI Christopher Smith MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 590
Burial Date Cemetery,Crematory or Facility Name
12/13/2021 Pine View Crematory
Entombment Address
0 Cremation Queensbury Town,New York
Donation
Z Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
d Date Point of
co Li Transportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
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
"S Address
CC
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/13/2021 Registrar of Vital Statistics WO-artf?n/rew Curtis glectronicall;Signe4
(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:
H `J
Z Date of Disposition 4114174 Place of Disposition X in.e,Viy r
,o...--
LU
2 (address)
W
NCC (section) (lot number) (grave number)
gName of Sexton or Person in Charge of Premises a a L n.41k
Z (pl a print)
W ` X—' (P
Signature Title r,"Wi�C
DOH-1555(o7/18)p 1 of 2
•
1..5434
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#