Petruzzo, Letizia NEW YORK STATE DEPARTMENT OF HEALTH @
Bureau of Vital Records Burial - Transit Permit
Name First Middle
LeftistPetru�o Last I Sex
Date of Death Age I If Veteran of U.S.Armed Forces, Female09(04/2022 I84 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death ENatural Cause [accident
El Homicide ❑Suicide DU ndeterm ined Pending
W Medical Certifier Name Circumstances Investigation
Abigail Macomber PAe
PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed
city Of Glens Falls District Number
C. ,Town or Village _ Register Number
5601 456
Burial Date Cemetery,Crematory or Facility Name
X Entombment 09/12/2022 Pine View cemetery
Address
❑Cremation Queensbury Town,New York
DDonation
C❑Removal Date Place Removed
p and/or I and/or Held
N Hold Address
0
Transportation Date Point of
•y by Common I Shipment
Carrier Destination
Disinterment Date Cemetery Address
Date Cemetery Address III Reinterment
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home I01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
s Address
W
a.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/07/2022 Registrar of Vital Statistics Alva,:Aran S0
49
(signature)
District Number 5801 Place City Of Glens Fags
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
h-
Z Date of Disposition Q.\ of. a a Place of Disposition 1
( ess/
, AC 1 Ir
CC
/sedionJ ^ ,/�vt number (grave number)
•
Name of Sexton or Person in Charge of Premises - 1«�'?/
(rind IZ —
e/�• Title .f l nSignature
DON-1555toiI$ p1oil
Public Health Law Sec. 4145(2b)
Receipt
I
Human remains of l , .: , delivered on s, , 20 )
ne View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
PETRUZZO
NAME Letizia Petr zo Age:
84
Lot Owner: Antonio & Letizia
Lot# Adirondack # 10 Grave# 2
Case: Entombment
Died: 9,4.2 2 Interred: 9. 12.2 2
FuneralHome:singleton Sullivan Potter
Cemetery: Pine View
PETRUZZO Lot No. 10
Address 1, _.0-1E LS. A PI ACF, OIJFFNSBW Y 804 Section No.
Owner ANTONIO & I FTIZIA.,E.ETBU770 � Plot ADIRONDACK
Date 7/11/05��__..._.__.
APPROX. 400 Superficial ft. ag
Location
ilQ.UNDF.I)._Q.(`1. NQl3IH_BY _PAIR .SnnTH RY VArANT, FAST RY PATH, WFST RY MASTRANTnNI
Corner Posts
Remarks a 5./ it
Deed No. ;and changes) 3357
Payment Record PAID IN FULL 7/11/05 ($6,000.00)
Record of Interments
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7 S�p�Q/7' s ig 7677
Form No. 01