Torchetti, Thomas B ); it 1,C.
NEW YORK STATE DEPARTMENT OF HEALTH i
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Thomas B Torchetti Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/01/2022 69 Years War or Dates Navy
i_ Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death II Natural Cause Accident Homicide Suicide Undetermined Pending
✓ Circumstances Investigation
W Medical Certifier Name Title
O Timothy Murphy Coroner
Address
52 Haviland Avenue,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 507
Burial Date Cemetery,Crematory or Facility Name
10/05/2022 Pine View Crematory
Entombment Address 4
Cremation Queensbury Town,New York
Donation
o❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
a Date Point of
Cl)❑Transportation
CI by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
El
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
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/05/2022 Registrar of Vital Statistics gKeganWolin(ECectronicaCtySigned)
(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— � J /
Z Date of Disposition 10 b l2 Place of Disposition
� ,w 1 Jv r+4....---
2 (address)
W
cr N (section) /� (lot number)t `�^ (grave number)
0 Name of Sexton or Person in Charge of Premises if
Z (ple se print)
W Signature /� Title 1Cl�rn �
DOH-1555(07/t8)p 1 of 2
. r) s1 p•R r... 1
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#