Mastrantoni, Nadia Esther NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Nadia Esther Mastrantoni Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/07/2020 83 Years War or Dates
Place of Death Hospital,Institution or
City,Town or Village Glens Falls Street Address Glens Falls Hospital
WManner of Death ❑X Natural Cause ❑Accident Homicide Suicide ❑Undetermined ❑Pending
V Circumstances Investigation
ttJ Medical Certifier Name Title
Q Scott Biasetti MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 210
❑Burial Date Cemetery,Crematory or Facility Name
05/13/2020 Pine View Cemetery
Entombment Address
❑Cremation Queensbury,New York
❑Donation
z Removal Date Place Removed
and/or and/or Held
N
Hold Address
Transportation Date Point of
Q by Common Shipment
Carrier Destination
❑ Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
w
10" Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/12/2020 Registrar of Vital Statistics Wodert,7nrlrew Curtis(EketronicatySyned)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition Place of Disposition
Uj (address)
Uj
N (section) (lot number) (grave number)
zName of Sexton or Person in Charge of Premises
Z (please print)
W Signature Title
DOH-1555(07/18)p 1 of 2
.,aith Law Sec. 4145(2b)
010388
xeipt
Human remains of r delivered on ' = , 20
t
Pine View Cemetery Representing the fun e home named on burial permit
Official Funeral Directors Reg.or License#
Mastrantoni
NAME Age: g 3
Nadia Esther Mastrantoni
Lot Owner:
Angelo Mastrantoni
Lot# Grave#
Adirondack 35 2
Case:
Entombed
Died: Interred:
FuderalA020 5/13/2020
Singleton, Sullivan, Potter
Cemetery:
Pine View