Degladillo,Quinton Phillip LF
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Quinton Phillip Delgadillo Male
Date of Death Age If Veteran of U.S.Armed Forces,
06/12/2022 8 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
pManner of Death 0 Natural Cause Accident ❑Homicide Duicide Undetermined ❑Pending
VCircumstances Investigation
0 Medical Certifier Name Title
Timothy Murphy Coroner
Address
52 Haviland Avenue,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 321
X Burial Date Cemetery,Crematory or Facility Name
06/20/2022 Pine View Cemetery
Entombment Address
Cremation Queensbury,New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held
Hold Address
N
O. Date Point of
il»Dransportation
by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F Remains are Shipped,If Other than Above
Address
Q
W
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/16/2022 Registrar of Vital Statistics Megan No1in(ECectronica1Cy Signed)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:z
W Date of Disposition (Q Do. Place of Disposition a\ C)L3<3�Cie�42�i
2 (address)
w vi)614--SnH 1 .1�
(section) (lot number)) (grave number)
SName of Sexton or Person in Charge of Premises dnr,r e 4X—ck.S- ►
Z p (please print)
W Signature IBC �C. Title ( Y'i/1—�I�CZeY1 T
DOH-1555(o7/18)p t of 2
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#
DELGADILLO ( ...F)
NAME Quinton Phillip Delgadill6ge: 8
Lot Owner: Jasmine & Larry Luellen
Lot#WahTah Wah Grave# 451
Case: Concrete
Died: 6. 1 2 .2 2 Interred: 6.2 0.2 2
Funeral Home: Regan Denny Stafford
Cemetery: Pine View