Mastrantoni Sr., Peter NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Peter Mastrantoni,Sr. Male
Date of Death Age j If Veteran of U.S. Armed Forces,
August 18, 2011 88 War or Dates
. Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
C° Manner of Death n Natural Cause Accident Homicide Suicide n Undetermined Pending
U Circumstances Investigation
Li
Medical Certifier Name Title
O Suzanne Blood,MD
Address
14 Manor Dr.Queensbury,NY 12804
Death Certificate Filed District Number RegisteJ.,N)J Aber
City, Town or Village Glens Falls 5601 ��j�Fj
0 Burial Date Cemetery or Crematory
August 22, 2011 Pine View Cemetery
❑Entombment Address
❑Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
O —
Date Point of
NTransportation Shipment
p by Common Destination
Carrier
n Disinterment Date Cemetery Address
Reinterment Date 1 Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan& Denny Funeral Home ! 01443
Address
53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
I-. Remains are Shipped, If Other than Above
2 Address
ELF
w
o. Permission is hereby granted to dispose of the human remains ri ed ove i dicated.
Date Issued O� /L � '
/��/� Registrar of Vital Statistics
(signature)
District Number 5601 Place Glens Falls /k'Pc.-ya ..,E"/02+s lf/
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 8/22/11 Place of Disposition Pine View Cemetery
2 (address)
W
N Adirondack 5 3
CL (section) (lot number) (grave number)
pName of Sexton or Person 'n Charge of Premises Michael Genier
Z (please print)
W
Signature Title Superintendent
(over)
'OH-1555(02/2004)