Colon, Roberto (L_ -i'l Sp.)
NEW YORKSTATE DEPARTMENT OF HEALTH e ) , Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Roberto Colon Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/23/2022 60 Years War or Dates 1981-1983
1— Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death 0 Natural Cause Accident ❑Homicide Suicide Undetermined ❑Pending
C.) Circumstances Investigation
CI
Medical Certifier Name Title
Scott Biasetti MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 388
Burial Date Cemetery,Crematory or Facility Name
07/27/2022 Pine View Crematory
Entombment Address
JCremation Queensbury,New York
EiDonation
0❑Removal Date Place Removed
and/or and/or Held
F- Hold Address
N
0
a Date Point of
Cl)❑Transportation
p by Common Shipment
Carrier Destination
EIDisinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan&Denny Funeral Service 01444
Address
94 Saratoga Ave,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
1.. 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 07/26/2022 Registrar of Vital Statistics MeganWoliin(cE(ectronicallySigned)
(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:
I—
WDate of Disposition 2�a. ...k,�L Place of Disposition Pfr , V .t,,,, Gr'' ' o ryj
2 (address)
W
CC CC (section) ' (lot number) (grave numbe)
0 Name of Sexton or Person in Charge of Premises In e/,,5-i t4 f<.,S
(please print/
W Signature 4- /,- Title L!�<-'�19�f _
DOH-1555(07/18)p l 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#