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Lombardo, James NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex James Lombardo Male Date of Death Age If Veteran of U.S.Armed Forces, 12/05/2023 81 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address 35 Mac Arthur Drive,Glens Falls, New York 12801 p0 Manner of Death �Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title G William Borgos MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 572 Burial Date Cemetery,Crematory or Facility Name 12/08/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation g❑Removal Date Place Removed and/or o and/or Held N Hld Address (/) Transportation Date Point of a by Common Shipment Carrier Destination Disinterment Date Cemetery Address 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 Remains are Shipped,If Other than Above a Address W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/08/2023 Registrar of Vital Statistics Megan Wolin(ECectronicalry 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: Ih— W Date of Disposition JZ-9-Zo2 Place of Disposition )p l`;t' ) / fl/� (address/ N CC (section) (tot number) (grave number) gName of Sexton or Person in Charge f Pre is LF /YfeI.J l(.JP Z / please print/ W Signature � , k(l Title 6ee.7 t,400 DOH-1555(07/18)p 1 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#