Pronto, Duane Edward i F gt i 0
NEW YORK STATE DEPARTMENT OF HEALTH t,� ,/ Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Duane Edward Pronto Male
Date of Death Age If Veteran of U.S.Armed Forces,
09/06/2022 77 Years War or Dates
F— Place of Death Hospital,Institution or
W City,Town or Village Granville Village Street Address Granville Center for Rehabilitation and Nursing
p Manner of Death Natural Cause Accident ❑Homicide uSuicide FlUndetermined []Pending
W
U I—ICircumstances II ''Investigation
W Medical Certifier Name Title
a Shardul Koppar DO
Address
17 Madison St,Granville Village,New York 12832
Death Certificate Filed Village Of Granville District Number Register Number
City,Town or Village 5725 39
RBurial Date Cemetery,Crematory or Facility Name
09/08/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held
~ Hold Address
to
0
IL Date Point of
to❑Transportation Shipment
p by Common
Carrier Destination
ElDisinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
1 Remains are Shipped,If Other than Above
2 Address
Q
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/08/2022 Registrar of Vital Statistics Diana Scarlotta(ECectronicallySigned)
(signature)
District Number 5725 Place Village Of Granville
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
Z Date of Disposition 9 J?_7 ,x Place of Disposition .J ti ( 1 e,_J C4.6IVI I47 t"�
W2 (address)
W
Q (section) (lo;numb r) (grave number)
8 Name of Sexton or Person in Charge of Pre ses ,�RV(ihr,a I
Z (please print)
W Signature < )711 i/ Title , �
DOH-1555(07/18)p 1 of 2 1
_1 - 1
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing;the funeral home namedpn.buriul permit
Official Funeral Directors Reg.or License#