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Canale, Anthony jet 1S `-' NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit `, r Name First Middle Last Sex ' * Anthony Augustus Canale Male " Date of Death Age If Veteran of U.S. Armed Forces, March 30,2016 99 War or Dates US Army '>: Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address The Pines Of Glens Falls Manner of Deathwik Natural Cause pi Homicide n Suicide Undetermined C Pending Circumstances Investigation Medical Certifier 1Name Title Melissa Decker,MD "= Address -r; Queensbury,NY '- Death Certificate Filed District Number Register Number t;7 / 71 A.:',`., City, Town or Village Glens Falls,NY 5601 ❑Burial Date Cemetery or Crematory ❑Entombment April 1, 2016 Pine View Crematorium Address ©Cremation 51 Quaker Road,Queensbury,NY 12804 Date Place Removed ZO ni Removal and/or Held and/or Address H Hold U) 0 Date Point of Nri Transportation Shipment a by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address ; , Permit Issued to Registration Number 1t4 Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 t`< Address 1 407 Bay Road,Queensbury, NY 12804 Name of Funeral Firm Making Disposition or to Whom �' Remains are Shipped, If Other than Above Address "A Permission is hereby granted to dispose of the human remains described above) as indicated. Date Issued 3/3/ l C Registrar of Vital Statistics (signatur ) District Number 5 6 0 ( Place G L N s Fa `-\S A/ J I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition - Place of Disposition e 4.— C t... W (address) CO 11-(fi (section) got num (grave number) aName of Sexton or Person in Charge of Premises ffj,si*f9L `Z (dlease print) Signature Title (amptOg (over) DOH-1555(02/2004)