Santos, Emanuel Willaim � p-1
N EW YORK STATE DEPARTMENT OF HEALTH . Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Emanuel VViIliam Santos Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/08/2020 98 Years War or Dates VVWII
Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
p Manner of Death Natural Cause Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
U
W Medical Certifier Name Title
Eric Santell NP
Address
131 Lawrence St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 156
❑ Burial Date Cemetery,Crematory or Facility Name
03/12/2020 Pine View Crematory
Entombment Address
x Cremation Queensbury Town,New York
Donation
Z Removal Date Place Removed
O and/or and/or Held
F—usHold Address
O
a Date Point of
N Transportation Shipment
Q by Common
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition orto Whom
F. Remains are Shipped,If Other than Above
2 Address
IX
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/12/2020 Registrar of Vital Statistics ,7olrn Paul'Tranck(rEkctronicall Syned�
(signature)
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
f—
Z Date of Disposition Place of Disposition ;,� pl.�ee C Li
W (add
111
N (section) ( t nu ber) (grave number)
ccJ
GName of Sexton or Person in Cha, a of Premi `' F ao
Z l (please print)
W Signature / Title D T
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 01 3 2
Receipt
Human remains of l_ _._t -a delivered on , 20_
,Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#�