Constantine, Albert t4ui
NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Albert Constantine Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/05/2022 61 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death
(� Natural Cause ['Accident n Homicide �Suicide �Undetermined El Pending
Circumstances Investigation
U
W Medical Certifier Name Title
CI Scott Biasetti MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 90
Burial Date Cemetery,Crematory or Facility Name
02/10/2022 Pine View Crematorium
nEntombment Address
Cremation Queensbury Town,New York
ElDonation
Z Removal Date Place Removed
and/or and/or Held
H Hold Address
0 Date Point of
Cl) ❑Transportation Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
❑ 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 02/09/2022 Registrar of Vital Statistics Megan.Nohn(ECectronicaffy Signed)
(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
W Date of Disposition a--/p-}-3— Place of Disposition 9frv,,'_i<Af '_c,�yt� fly
2 (ad ress)
CC
(section) (lot number) (grave number)
g Name of Sexton or Person�n Char e of Premises T�f r���/ S��!f S
(please print)
W �Signature Title Lre.,,MA"'
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) _ x
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#