Saris, Anthony 52,2,
NEW YORK STATE DEPARTMENT OF HEALTH ' i
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Anthony Saris Male
Date of Death Age If Veteran of U.S. Armed Forces,
s October 17, 2011 88 War or Dates World War II
Z�wn Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
• Manner of Death X Natural Cause 1 I Accident Homicide Suicide Undetermined Pending
US Circumstances Investigation
w° Medical Certifier Name Title
Mary C.Kilayko Dr.
Address
:: § 100 Park St.,Glens Falls,NY 12801
°; Death Certificate Filed District Number Rest rpmber
City, Town or Village Glens Falls 5601
❑Burial Date Cemetery or Crematory
October 18, 2011 Pine View Crematorium
❑Entombment Address
El Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z n Removal and/or Held
and/or Address
H Hold
U)
O Date Point of
N [ I Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
y Permit Issued to Registration Number
!:: Name of Funeral Home Regan& Denny Funeral Home 01443
;,a; Address
53 Quaker Road, Queensbury,NY 12804
; ' Name of Funeral Firm Making Disposition or to Whom
' Remains are Shipped, If Other than Above
X Address
CZ
:. Permission is hereby granted to dispose of the human remains descr' e a ov as 2ted.
•
Date Issued /D 8 ZO/f Registrar of Vital Statistics
aY1 (signature)
urj District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition p i to i i\ Place of Disposition f iv tJuti C,vtu-or!v,.
2 (address)
W
U)
CL (section) (lot number) (grave number)
Q Name of Sexton or Pers n in Chargehf Premises 4),
c;�kr ,nK
Z /1.6 (please print)
W Title CI?eM -(6(
Signature
(over)
DOH-1555(02/2004)