Di Santo, Glenn 1 + Li
NEW YORK STATE DEPARTMENT OF HEALTH 4
Vital Records Section Burial - Transit Permit
in Name First Middle Last Sex
Glenn DiSanto Male
Date of Death Age If Veteran of U.S. Armed Forces,
01 / 14 / 2017 62 War or Dates N/A
1- Place of Death Hospital, Institution or
Z City, Town or Village Easton Street Address 32 Freeman Road
a Manner of Death I Natural Cause 0 Accident Homicide ❑Suicide 0 Undetermined 0 Pending
LtE Circumstances Investigation
in Medical Certifier Name Title
a John Delmonte MD
Address
3 Care Ln Suite 300, Saratoga Springs, NY 12866
Death Certificate Filed District Number Register Number
City, Town or Village Easton
' Burial Date Cemetery or Crematory
O1 / 16/ 2017 Pine View Crematory
01 DEntombment Address
.0Cremation Queensbury, NY
Date Place Removed
Z Removal and/or Held
2❑and/or Address
t Hold
C) Date Point of
Iiii Q Transportation Shipment
C3 by Common Destination
id Carrier
iiit
❑Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
iiii:i'> Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
: Address
i. 402 Maple Ave., Saratoga Sp., NY 12866
Mii Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
. Address
ipi
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Mf Permission is reby granted to dispose of the human re ains described above as indicated.
Date Issued / 7 ,�o/.7 Registrar of Vital Statistics .6.� ,�apok,..
(signature)
' District NumbeL5-7) j Place Easton , New York
'' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
Iii Date of Disposition /J/7�/7 Place of Disposition j Q(>I G c74,fo�
a / (address(
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Cr (section) Jlyrt number) (grave number)
g Name of Sexton • ";op,ip C arge of Premises — 04:wrt k�
(please print)
it
Signature , . \ % Title �/�/'n4-'-�f I9Per (
l (over)
DOH-1555 (02/2004)