Santasiero, Philip NEW YORK STATE DEPARTMENT OF HEALTH + t ��
Vital Records Section Burial - Transit Permit
^ Name First Middle Last Sex
Philip A. Santasiero Female
. Date of Death Age If Veteran of U.S. Armed Forces,
o. June 16,2017 91 War or Dates
Place of Death Hospital, Institution or
i=' City, Town or Village Queensbury 1 Street Address 195 Robert Gardens North
04: Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
41 Circumstances Investigation
w Medical Certifier Name Title
Daniel Sooriabalan
Address
'HHHN
Death,.0 'ficate Filed Di rict Number R is er Number
City own r Village (--�(A,`Q'2? �
❑Burial Date Cemetery or Crematory
June 19,2017 I Pine View Crematory
El Entombment Address
❑x Cremation Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
F Hold
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0 Date j Point of
NTransportation 1 Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
°_'`$ Permit Issued to 1 Registration Number
.: Name of Funeral Home Alexander-Baker Funeral Home 00035
Address
3809 Main Street,Warrensburg, NY 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2. Address
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Permission is herebylI granted to dispose of the human emains described((1 above as indicated.
Date Issued Lai to,tool 7 Registrar of Vital Statistics G''�,`--( , C fi
(signature)`
District NumbecZ Place , \ C._ __ uts2j2,7,sio
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I certify that the remains of the decedent identified above were disposed of in a ordan e with this permit on:
Z p
uni Date of Disposition 4 hp l(, Place of Disposition T',ta,J otops
2 (address)
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p0 (section) /(lot number) (grave number)
Name of Sexton or Person in Charge of Premises f7t,. r Si14ii'
Z (ple se print)
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Signature Title 011, 1 rb1'L
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DOH-1555 (02/2004)