Trapasso, Tony Ralph 4- 3y
NEW YORKSTATE DEPARTMENT OF HEALTH v Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Tony Ralph Trapasso Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/07/2022 61 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Warrensburg Town Street Address 26 Summit Street,Warrensburg Town, New York 12885
pManner of Death Natural Cause ❑Accident ❑Homicide I:ISuicide Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
Jaime Bickford DO
Address
315 S.Manning Boulevard,Albany,New York 12208
Death Certificate Filed District Number Register Number
City,Town or Village Warrensburg 5660 1
Burial Date Cemetery,Crematory or Facility Name
01/12/2022 Pine View Crematory
Entombment Address
lCremation Queensbury Town,New York
❑Donation
ElRemoval Date Place Removed
and/or and/or Held
- Hold Address
N
0
a. Date Point of
CO Li Transportation
El Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
ElReinterment 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
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/11/2022 Registrar of Vital Statistics Tame&z 1L(oyd(ECectronicalTySigned)
(signature)
District Number 5660 Place Warrensburg, 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 I/IZ In Place of Disposition u ` ZtOt'•��
2 (address)
W
N (section) (lot number /grave number)
8 Name of Sexton or Person in Charge of P miser (NAIL' ` ,
Z (please print)
LU Signature __y`S!s Title �2o%0�✓i��
g
DOH-1555(07/18)p 1 of 2
O 5
a °+.F
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#