Falasco, Jessie Lucille NEW YORK STATE DEPARTMENT OF HEALTH (L?) Burial — Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Jessie Lucille Falasco Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/28/2023 74 Years War or Dates
▪ Place of Death Hospital,Institution or
• City,Town or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death Ei Undetermined Pending
G Natural Cause Accident Homicide Suicide
W Circumstances Investigation
W Medical Certifier Name Title
O Mathew Varughese DO
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 358
X Burial Date Cemetery,Crematory or Facility Name
08/04/2023 Pine View Cemetery
Entombment
_ Address
['Cremation Queensbury,New York
Donation
Z Removal Date Place Removed
and/or and/or Held
- Hold Address
N
0
Date Point of
N Transportation Shipment
p by Common
Carrier Destination
['Disinterment
Cemetery Address
ID Reinterment
Date Cemetery Address
" Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
2 Address
LIC
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/31/2023 Registrar of Vital Statistics Megan No(in(ECectronicalTy Signed)
(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:� ����
III
Date of Disposition 4�_ (4•,D Place of Disposition ak �(e� ' Eft��Cl 1 rt4 Ny /n7f3011
l (address)
JJ // '
W 1(0 Y "R ave number)
ac (section) lot nummbber)p� (grave
2 Name of Sexton or Person in Charge of Premises ,, ni']i GUe"�''"
(please print)UJ Signature141141-4 4. feYi. Title cZ 1 n 'K/cid
DOH-1555(07/18)p 1 of 2
, .
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PubliC Health Law Sec. 4145(2b)' 012993
Receipt
. ,
, .
Human remains of - ---`- - , ' .' - ' delivered on '- '/, I ,
i ' 1
1 1
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• e View Cemetery Representing'the funeral home named on burial permit
Official Funeral Directors Reg.or License# 1 `,
FALASCO
Lot No. 38
Address RD 1 Box 1473 . Lake Georsle, NY 12845 (1.-4F3)-
Section No. B
Owner Philip & Jessie Falasco Plot Mohican
Date 10/1/92
Approx . 133 Superficial ft. @
Location Bounded on North by Vacant , South by Falasco, East by Laurent &
Sherman, West by Vacant .
Corner Posts
Remarks
Deed No. (and changes) 2473
Payment Record Paid in Full 10/1/92
Record of Interments
1 .� Sl e L.- �Qb. - 8-(-1.o : `l-ae-cV •
2 Philip J. Falasco 09/04/2007 V
3 John S . Stranahan 10/1/92
4 Barbara R. Stranahan 2/22/96 /�
5 lx
67r7
8
Form No. 01
FALASCO V
NAME Jessie L. Falasco Age: 74 /�
Lot Owner: Philip & Jessie Falasco
Lot# Mohican 38 B Grave 41
Case: Concrete
Died: 7.2 8.2 3 Interred:8.4.23
Funeral Home: Singleton, Sullivan Potter
Cemetery: Pine View