Mistretta II, Salvatore NEW YORK STATE DEPARTMENT OF HEALTH r , ti r' 00
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Salvatore J. Mistretta,II Male
Date of Death Age If Veteran of U.S. Armed Forces,
=_ August 19,2015 89 War or Dates World War II
Place of Death Hospital, Institution or
City, Town or Village Johnsburg Street Address 24 Edwards Hill Road, Bakers Mills
Manner of Death X Natural Cause Accident I I Homicide Suicide Undetermined Pending
iiiCircumstances Investigation
ui Medical Certifier Name Title
C? Jennifer Donovan
Address
HHIHN,Johnsburg,NY 12843
Death Certificate Filed District Number Register Number
City, Town or Village Johnsburg 5655 Q C.4
❑Burial Date Cemetery or Crematory
❑Entombment August 21,2015 Pine View Crematory
Address
EX Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
Hold
co
O Date Point of
tali I I Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
I I Reinterment
Date Cemetery Address
y` Permit Issued to Registration Number
v Name of Funeral Home Alexander-Baker Funeral Home 00037
I Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
1-` Remains are Shipped, If Other than Above
' Address
W.
Permission is hereby granted ..
� to dispose of the human re described abov as indica ed.
„= Date Issued 8 -pD.) `Q&'\J Registrar of Vital Statistics na
(signature)
District Number 5655 Place Johnsburg,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z l
'Li Date of Disposition giZ'1��tj- Place of Disposition g k.., t'oriref1~
2 (address)
Cl)IA
CL (section) it -(lot num er) (grave number)
p Name of Sexton or Person in Charge of Premises (40 3tw4f
Z I, tease print)
LLI
Signature Title /liriAi /f
(over)
DOH-1555 (02/2004)