Depasquale, Anthony NEW YORK STATE DEPARTMENT OF HEALTH If -7g
Vital Records Section Burial - Transit Permit
is Name First Middle Last Sex
Anthony Depasquale Male
Date of Death Age If Veteran of U.S. Armed Forces,
12/17/2014 45 years War or Dates
Place of Death Hospital, Institution or
Ei City, Tovimoyixx Saratoga S rings Street Address Sarato a Hospital .
a Manner of Death❑�latural Cause Accident 0 Homicide Suicide Li Undetermined ri Pending
tF Circumstances Investigation
W Medical Certifier Name Title
fl Mikhail Mavah v M D
Address
211 Church Street, Saratoga Springs, N Y 12866
Death Certificate Filed District Number Register Number
Ni City, TovjVijtx Saratoga Springs 4Sn1 566
DBurial Date Cemetery or Crematory
❑Entombment 1 2/1 81201 4 Pine Vapw Crematory
Address
❑cremation Queensbury, N Y
Date Place Removed
Z❑Removal and/or Held
and/or Address
E Hold
0 Date Point of
Ili,�Transportation
! Shipment
C by Common Destination
iM Carrier
D Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Ni Address
402 Maple Ave.. Saratoga Springs, NY
iii Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
I
W.
Permission is hereby granted to dispose of the human rem ' e cribled a! indicat
•
Date Issued 12/18/2014 Registrar of Vital Statistics Q.�� i
gi (signature)
District Number;:,': 4501 Placeio:ii Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition it/,1 A Place of Disposition �'",�. Us,..a Cr for
(address)
in
CA
CC (section) /% (lot number) (grave number)
laName of Sexton or Pers n in Charg of Premises �"'' I-... 3 e/44%A'
2 (p ase print)
itit Signature '` � Title t IL ► i �
(over)
DOH-1555 (02/2004)