Di Santo, Brett i t ` )3
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Brett DiSanto Male
Date of Death Age If Veteran of U.S. Armed Forces,
04 / 24 / 2017 26 War or Dates N/A
}- Place of Death Hospital, Institution or
Z City, Town or Village Easton Street Address 32 Freeman Road
tij
0 Manner of Death❑ Natural Cause E Accident E Homicide ❑Suicide ❑Undetermined ®Pending
tilCircumstances Investigation
in Medical Certifier Name Title
ct Robert D. Lemieux Coroner
Address
219 Pope Hill Road, Argyle, NY 12809
Death Certificate Filed District Number Register Number
City, Town or Village Easton
Ai(Burial Date Cemetery or Crematory
04 / 27 / 2017
r [ Entombment 1 Pine View Crematory
Address
Cremation Queensbury, NY
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
O.
Transportation Shipment
C by Common Destination
Carrier
m LiDisinterment Date Cemetery Address
Q Renterment Date Cemetery Address
Mii Permit Issued to Registration Number
ge Name of Funeral Home Compassionate Funeral Care 00364
>: Address
402 Maple Ave., Saratoga Sp., NY 12866
iliiIiiii Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
ie
ILI
Permission is hereby granted to dispose of the human remains described above as indicated.
Mi
Date Issued Li—a7-/7 Registrar of Vital Statistics �y c-.--
(signature)
iin District Number 5 7 b 3 Place Easton , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
#i-
WDate of Disposition ti 11$/n Place of Disposition 'f►at\ (rirnatdr;w..,
(address)
lit
ilr (section) (lot number) (grave number)
0
0 Name of Sexton or Person ip Charge of P mises �r s S,i+�1t
Z (please print) •
ttiSignature v� —/ Title IRk.MYI
bt
(over)
DOH-1555 (02/2004)