Zaffo, Paul G , v # 75")
NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Paul G.Zaffo Male
Date of Death Age If Veteran of U.S.Armed Forces,
09/22/2022 72 Years War or Dates
i_ Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address Glens Falls Hospital
1p Manner of Death EI Natural Cause Accident Homicide Suicide ❑Undetermined ❑Pending
C.) Circumstances Investigation
W Medical Certifier Name Title
G Gwendolyn Monts-Dickinson PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
Cit ,Town or Village 5801 490
Burial Date
Entombment Cemetery,Crematory or Facility Name
0 ddres022 Pine View Crematory
Address
Cremation Oueensbury Town,New York
Don ation
O Removal Date Place Removed
F and/or and/or Held
— Hold Address
0
IL Date Point of
U) Transportation
El Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
O
Re interment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
(— Remains are Shipped,If Other than Above
S Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/23/2022 Registrar of Vital Statistics .4Logan.r`Yolsn(E ctronrcay.Sigrrsd)
(signalure)
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 perrniton:
WtDate of Disposition �,q'7'/-tpx Place of Disposition !f7;Ale j4'.r?',. ri-ejtk
2 (address)
W
N
CC (section) a (lot number) (gra we number)
gName of Sexton or Person in Charge Premi i l A f/04 A T) p)(10,1
(please print)
1Z v''
Signature q1/4
. / d Title Orefe-1
DOH-1555(o7/t8)p 1 of 2
a4
Public Health Law Sec. 4145(2b)
Receipt
Human remains of r delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#