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Mastrantoni, Jr. Peter -4 NEW YORK STATE DEPARTMENT OFEALThh SL4) Vital Records Section Burial - Transit Permit Name First Middle Last Sex Peter Mastrantoni,Jr. Male Date of Death Age If Veteran of U.S. Armed Forces, July 20, 2011 66 War or Dates ZY4 Place of Death Hospital, Institution or City, Town or Village Glens Falls ; Street Address Glens Falls Hospital es Manner of Death X Natural Cause Accident n Homicide n Suicide n Undetermined Pending b3 Circumstances Investigation Medical Certifier Name Title P. James North,MD ;;.i Address Glens Falls,NY i:ii Death Certificate Filed District Number Register Numper City, Town or Village Glens Falls,NY 5601 3 z ❑Burial Date Cemetery or Crematory ❑Entombment July 22,2011 Pine View Crematorium Address ©Cremation 21 Quaker Road, Queensbury, NY 12804 Date Place Removed Z Removal and/or Held and/or Address F Hold O — Date Point of u _Transportation Shipment p 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 Address :; 53 Quaker Road, Queensbury,NY 12804 e Name of Funeral Firm Making Disposition or to Whom • Remains are Shipped, If Other than Above S Address rz if • Permission is hereby granted to dispose of the human remains described above as indicated. rya Date Issued "'1 1 21/( I Registrar of Vital Statistics Uk)CLkir1^42 Wc (signatur District Number 5601 Place Glens Falls,NY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition•2/Gotyt( Place of Disposition gne t t'.p Ckerhq +jr i urei z (address) W N CL (sectio (l�number) (grave number) p Name of Sexton or P-rson in Ch- ,,a of Premises i Im o ne l-e 'LI Z ��►. / / w (please print) Signature „...1_, I��, Title Cr-co 5 (over) DOH-1555(02/2004)