Caldaroni, Alfredo • # SSS
NEW YORKSTATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Permit
Name First 'Middle Last Sex
Alfredo Caldaroni Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/12/2022 87 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Lake George Town Street Address 2724 State Route 9,Lake George Town,New York 12845
ILI• Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
O Mary Stein NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Lake George District Number Register Number
City,Town or Village 5651 14
Burial Date Cemetery,Crematory or Facility Name
07/14/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
N Hold Address
0
O. Date Point of
CO Dransportation
p by Common Shipment
Carrier Destination
O
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
2 Address
Q
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/13/2022 Registrar of Vital Statistics Patricia RWc7(inney-Schuster(E(ectronwalTySigned)
(signature)
District Number 5651 Place Town Of Lake George
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 7 I i Silt Place of Disposition ��,
�-
W
(address)
W
N
Q (section) (lot number) _ fi (grave number)
O Name of Sexton or Person in C e f Premises Z (plea rint) .504
W Signature TitleAIM/��k-
DOH-1555(07/18)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#