Sanchez Jr., Angel NEW YORK STATE DEPARTMENT OF HEALTH = • * % # 3
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Angel Luis Sanchez Jr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
January 7, 2017 51 War or Dates
Place of Death Hospital, Institution or
f; City, Town or Village Wilton Street Address 120 Ballard Road#26
rit! Manner of Death ❑Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined Dri0 Pending
Circumstances Investigation
Medical Certifier Name Title
Michael Sikirica , Dr.
Address
50 Broad Street Ste 1 Waterford, NY 12188
4.1 Death Certificate Filed District Number Register Number
City, Town or Village Wilton 03 2 '
❑Burial Date Cemetery or Crematory
January 10, 2017 Pine View Crematory
v ❑Entombment Address
M Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
ri Removal and/or Held
and/or Address
Hold
m.
Date Point of
❑Transportation Shipment
,i'a by Common Destination
w Carrier
Disinterment Date Cemetery Address
0 Reinterment
Date Cemetery Address
47,11,
Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home-SGF 01078
-4 Address
136 Main Street, South Glens Falls NY 12803
r Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
- Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Registrar of Vital Statistics ),��i`-
Date Issued g 1� y = 1
(sign re)
District Number / `` Place Z 2 /5 / /jh—
II I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 01/10/2017 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) f� (lot numb (grave number)
Name of Sexton or Person in Charge of Pr raises
(please print)
i Signature ZI Title
OiAr4/1•Pfl-
'''''.
(over)
DOH-1555 (02/2004)