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Fiato, Daniel Scott
tr %• NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Daniel Scott Fiato Male Date of Death Age If Veteran of U.S.Armed Forces, 01/31/2022 59 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Granville Town Street Address 7187 Route 149,Granville Town,New York 12832 pManner of Death © Natural Cause El Accident El Homicide Suicide Undetermined Pending WU Circumstances Investigation ut Medical Certifier Name Title 0 Charles Yun MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number I Register Number City,Town or Village Granville 5756 I 8 QBurial Date Cemetery,Crematory or Facility Name 02/01/2022 Pine View Crematorium EiEntombment s Address 0 Cremation Queensbury Town,New York El Donation 8 Removal Date Place Removed and/or ` and/or Held N Hold ` Address 0 a Date Point of 0) Li Transportation Shipment p by Common 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 E— Remains are Shipped,If Other than Above Address CC W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/01/2022 Registrar of Vital Statistics 9eirnvC.inda ofllartelre(1-CectrorricalTySigned) (signature) District Number 5756 Place Granville, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z _�_ W Date of Disposition �, — Place of Disposition 135 � ` 2 (ad dres y s) w (section) _ (lot number) (grave number) 0 Name of Sexton or Per n in Charge of Premises e r GX f IA f't 5 (please print) lW Signature Title Cc' mac'( DOH-1555(07/18)p t of 2 • 0 15598 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on ' , 20 Pine View Cemetery Representing the funeral home named pp buri permit Official Funeral Directors Reg.or License# ; `"