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Infantino, Anthony NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Anthony J. Infantino Male Date of Death Age If Veteran of U.S. Armed Forces, April 8,2012 94 War or Dates Place of Death Hospital, InstitutiorMirondack Tri-County Health Care City, Town or Village Johnsburg Street Address Center a Manner of Death I Xi Natural Cause I I Accident I I Homicide Suicide Undetermined Pending ; , Circumstances Investigation tu Medical Certifier Name Title James Hindson Dr. Address Main St.,Warrensburg,NY 12885 Death Certificate Filed District Number Register Number City, Town or Village Johnsburg 5655 13 ❑Burial Date Cemetery or Crematory April 9,2012 Pine View Crematory C Entombment Address ©Cremation Quaker Rd., Queensbury,NY 12804 Date Place Removed Z Removal and/or Held O and/or Address H Hold N O Date Point of N ' (Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address <`. Permit Issued to Registration Number u, Name of Funeral Home Alexander-Baker Funeral Home 00035 9-. Address 3809 Main Street,Warrensburg,NY 12885 Name of Funeral Firm Making Disposition or to Whom I. Remains are Shipped, If Other than Above Address tea Permission is hereby granted to dispose of the human re ains described above as 'ndicated. Date Issued �}-9-- la . Registrar of Vital Statistics ca � (signature) District Number 5655 Place Johnsburg I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z w Date of Disposition ({1 to tit Place of Disposition U"—) C eto(� 2 (address) W CA CC (section) n (lot nuprtrer)� (grave number) O• Name of Sexton or Person in Char of Premises rtyfiel��r J t►�'i Z (please print) W Signature _ Title ��n� dl2 ��11 (over) DOH-1555 (02/2004)