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Livote, Nicholas # , C NEWYORKSTATEDEPARTMENTOFHEALTH :' � Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Nicholas Livote Male Date of Death Age If Veteran of U.S.Armed Forces, 02/20/2024 85 Years War or Dates i— Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital UJ 0 Manner of Death El Natural Cause Accident 0 Homicide Suicide ❑Undetermined Pending W U Circumstances Investigation QW Medical Certifier Name Title Bo Li MD Address 100 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 106 —Burial Date Cemetery,Crematory or Facility Name 02/22/2024 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York DDonation Z❑Removal Date Place Removed p and/or and/or Held N Hold Address 2 Date Point of U)❑Transportation Ei by Common Shipment Carrier Destination EDisinterment 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 I— Remains are Shipped,If Other than Above 2 Address Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/22/2024 Registrar of Vital Statistics Megan Wolin(ECectronica1Ty 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: Date of Disposition 2123IZy Place of Disposition Ft+vf4(-; Cl 11A ^tom LU 2 (address) W CC N (section) r(lot number) (grave number) SName of Sexton or Person in Charge of remises ,A P,Mk lit (please print) Z , ,.2 W Signature Title � /n/�To R DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) a "" Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#