Manzella, Antonino NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section 41, Burial - Transit Permit
Name First Middle Last Sex
Antonin Domenico Manzella Male
Date of Death Age If Veteran of U.S. Armed Forces,
February 7,2018 54 War or Dates n/a
f Place of Death Hospital, Institution or
City, Town or Village Queensbury,NY Street Address 6 Mohawk Trail
Manner of Death 0 Natural Cause 0 Accident 0 Homicide E Suicide 0 Undetermined n Pending
Circumstances Investigation
,iMedical Certifier Name Title
Jennifer Stratton,MD
Address
Queensbury,NY
Death Certificate Filed District Number Register Number
City, Town or Village Queensbury,NY 5657 tp.
❑Burial Date Cemetery or Crematory
❑Entombment February 12,2018 Pine View Crematory
Address
®Cremation Queensbury,NY
Date Place Removed
ZO Removal and/or Held
and/or Address
H Hold
Cl)
O Date Point of
ca Li Transportation Shipment
p by Common Destination
Carrier
Date Cemetery Address
r- Disinterment
n Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road,Queensbury,NY
Name of Funeral Firm Making Disposition or to Whom
III: Remains are Shipped, If Other than Above
a Address
it
Lit
0 Permission is hereby granted to dispose of the human rema' a cri, bpv ' dicated.
Date Issued ' .-_q— I Registrar of Vital Statistics t c c
—� (signature)
District Number (.6,✓1 Place /( 3 ,��.,� 6A-LA ------
▪ I certify that the remains of the decedent identified above re disposed of in a rdance ' h this permit on:
Date of Disposition 21 13)ib Place of Disposition e..V.-1
2 (address)
CO
fY (section) (lot number) S (grave number)
p0 Name of Sexton or Person in Charge of Premises ,,, j- .titi'
`Z i i lease print)
Signature Title filEw 'Zt,
(over)
DOH-1555(02/2004)