Scarangello, Matthew : . , tY6C)�
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section ,
Name First Middle Last Sex
Matthew J. Scarangello Male
Date of Death Age . If Veteran of U.S. Armed Forces,
August 11, 2015 48 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Buffalo Street Address 175 North Street Apt. 801
W
Manner of Death I I Natural Cause I I Accident Homicide Suicide Undetermined x Pending
Circumstances Investigation
W Medical Certifier Name Title
O Nicole A. Yarid MD
Address
501 Kensington Ave.,Buffalo,NY 14214
Death Certificate Filed District Number 14101
Register Number
City, Town or Village 3
❑Burial Date Cemetery or Crematory
❑Entombment August 18, 2015 Pine View Crematory
Address
0 Cremation Queensbury, NY
Date Place Removed
Z Removal and/or Held
0, and/or Address
H Hold
to
O Date Point of
I Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave., Saratoga Springs, NY 12866
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped, If Other than Above
2 Address
W.
LL'
Permission is hereby granted to dispose of the human remaim described above as in•icated.
Date Issued t 7 (5 Registrar of Vital Statistics ' 4`. -4 , 1
(signature)
District Number 14 Q, Place
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition 9/orbs, Place of Disposition,,,, ` g,,,
(address)
W
N
g (section) Af ( t number) (grave number)
CI• Name of Sexton or Person in Charge of Premises `J�
W al- (phase print)Signature -4 Title RIri1# e
(over)
DOH-1555 (02/2004)