Spizzo Jr., Joh Vincent NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
John Vincent Spizzo Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/25/2021 89 Years War or Dates 1951-1955
Place of Death Hospital,Institution or
WCity,Town or Village Queensbury Town Street Address Glens Falls Center for Rehabilitation and Nursing
p Manner of Death Natural Cause ❑Accident ❑Homicide ❑Suicide El Undetermined Pending
W Circumstances Investigation
U
W Medical Certifier Name Title
0 Wendy Steinhacker PA
Address
152 Sherman Ave,Queensbury Town,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 247
❑Burial Date Cemetery,Crematory or Facility Name
12/28/2021 Pine View Crematorium
❑Entombment Address
Cremation Queensbury Town,New York
❑Donation
Removal Date Place Removed
Is 0and/or and/or Held
F- Hold Address
N
0
Date Point of
(I) ❑Transportation
Q by Common Shipment
Carrier Destination
❑Disinterment
Date Cemetery Address
Date Cemetery Address
El Reinterment
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
—. Remains are Shipped,If Other than Above
5 Address
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/27/2021 Registrar of Vital Statistics Caroline Ni°arde Barber(ECectronicalry Signed)
(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:
WDate of Disposition /. - 2vz f Place of Disposition .C- op t � C� r i.t t—�
2 (address)
W
CC
t/) (section) (lot',Ember) (grave number)
Name of Sexton or Person in Char f Premis tA1 C"P
/please print)
W Signature Title ( �J r
DOH-1555(07/18)p 1 of 2 _v
015490
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#