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Guasco, Dante V
f v NEW YORK STATE DEPARTMENT OF HEALTH i Bureau of Vitat Records Burial - Transit Permit Name First Middle Last Sex Dante V.Guasco Male Date of Death Age If Veteran of U.S.Armed Forces, 01/31/2022 100 Years War or Dates WWII 1.., Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation Manner of Death ©Natural Cause EI Accident El Homicide El Suicide 0 Undetermined El Pending Circumstances Investigation a Medical Certifier Name Title Courtney Diamond NP Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 68 Burial Date Cemetery,Crematory or Facility Name 01/31/2022 Pine View Crematory ❑Entombment Address lCremation Queensbury Town,New York 0 Donation Z Removal Date Place Removed 0 ElF= and/or and/or Held N Hold Address 0 1-1 VI Li Transportation Date Point of a by Common Shipment Carrier Destination 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 H Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/31/2022 Registrar of Vital Statistics Megan North(ECectronica1TySigned) (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: Date of Disposition Z 11 1 ZZ Place of Disposition ',A Zi c W (address W CO (sertion) (lot number) (grave number) 8 Name of Sexton or Person in Charge of Premises e s 1'►42 tt Z %Tease print) /� IU Signature Title ` M 4 DOH-1555(07/18)p 1 of 2 A U96 Public Health Law Sec. 4145(2b) Receipt 1. Human remains of delivered on , 20 1 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#