Marcantonio, Anthony . pry � c�2o
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Anthony Raymond Marcantonio Male
Date of Death Age If Veteran of U.S. Armed Forces,
ni JUne 10, 201.6 68 War or Dates Yes
144 Place of Death City of Glens Falls Hospital, Institution or Glens Falls Hospital
Z City, Town or Village Street Address
tti
ci Manner of Death®Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined El Pending
ta Circumstances Investigation
in Meddj�cal Certrtifi NE e Title
CI
nark Ho fman
Address
102 Park St. Glens Falls, New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village City of GLens Falls 5601
<;` ❑Burial Date Cemetery or Crematory
❑Entombment June 13, 2016 Pine View Crematory
i]iiiiAddress
Ni®Cremation 21 Qukaer Road Queensbury, NEw York 12804
Date Place Removed
Z n Removal and/or Held
i2 I—land/or
Address
to
Hold
O Date Point of
EL Transportation Shipment
0 by Common Destination
Carrier
El Disinterment Date Cemetery Address
El Reinterment Date Cemetery Address
Ni$ Permit Issued to Registration Number
ii
Name of Funeral HomeM' B• Kilmer Funeral Home 01 078
iN Address
136 Main St. South GLens Falls, NEw York 12803
ni Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
tr
ta
fl` Permission is hereby granted to dispose of the human remains described
�a-bov as i c ted.
Date Issued 6-1 3-1 6 Registrar of Vital Statistics itt,/ ' e „/
(signature)
District Number ;5-6(9/ Place City of GLens Falls , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I .
W Date of Disposition (O 1ni/b Place of Disposition frit 0,,../ .,�
address
iti
to
lc (section) c(lot numb (grave number)
ci Name of Sexton or Person in Chargeof Premises 'f G"
2 a (p ase print)
ta Signature Title � 12
(over)
DOH-1555 (02/2004)