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Malachuk, Allan
a YORKSTATE DEPARTMENT OFHEALTH Burial - Transit Permit eau of Vital Records Name First Middle Last Sex Allan Malachuk Male Date of Death Age If Veteran of U.S.Armed Forces, 04/19/2020 79 Years War or Dates 1963 �.. Place of Death Hospital,Institution or W City,Town or ViUage Glen Cove Street Address Glengariff Corp 'p Mannerof Death © Natural Cause 1:1Accident Homicide Suicide ❑Undetermined Pending Circumstances Investigation W Medical Certifier Name Title John Reyes MD Address 141 Dosoris Ln,Glen Cove,New York 11542 Death Certificate Filed District Number Register Number City,Town orVitlage Glen Cove 2901 230 Burial Date Cemetery,Crematory or Facility Name 05/01/2020 Pineview Crematory Entombment Address RCremation Queensbury,New York Donation z Removal Date Place Removed and/or and/or Held H asHold Address O IL Date Point of U) 0 Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home D'Arienze Funeral Home Inc 00407 Address 104 Skillman Ave,Brooklyn,New York 11211 Name of Funeral Firm Making Disposition orto Whom H Remains are Shipped,If Other than Above 2 Address IM W I' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/28/2020 Registrar of Vital Statistics Gaspare G 7ummineClo(ECectronicaCCySigned) (signature) District Number 2901 Place Glen Cove, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition �DZv Place of Disposition y, �e C e-m (address) g W N (section) number) (grave number) M Name of Se?cton or Person' Cha of Premises ��" ` GvV n-tC. a (please print) W Signature Title 6—r2 rvi,c-4-z�,' d / DOH-1555(07/18)p 1 of 2 % MF y Public Health Law Sec. 4145(2b) ,Jk 3 7 ? Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#