Notarangelo, Louis NEW YORK STATE DEPARTMENT OF HEALTh1 `-' ii 71 16 i
Vital Records Section Burial - Transit Permit
Name F ouis Middle r4ofarangelo Seklale
Date of Death A e If Veteran of U.S. Armed Forces,
02/22/2013 8'4 years War or Dates 1946-1947
Place of Death Hospital, Institution or
W City,# on Saratoga Springs Street Address 125 West Ave. Apt. 117
W Manner of Death fl Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
la Medical Certifier Name Title
L Syed Mehdi M D
AfIldrFicilland Avenue, Albany, N Y 12208
Death Certificate Filed District Number Reggister Number
City,* o /i, a Saratoga Springs 4501 104
Ni['Burial Date Cemetery or Crematory
02/26/2013 Pine View Cemetery
iN❑Entombment Address •
M❑Cremation Queensbury N Y .
Date Place Removed
Removal and/or Held
pz 1—i and/Holdor
Address
CA •. Date Point of
d niin Li Transportation Shipment
at by Common Destination
Carrier
❑Disinterment Date Cemetery Address
,iii ❑Reinterment Date Cemetery Address
•
Permit Issued to Reais3trrat ion Number
Name of Funeral Home Compassionate Care, Inc. 00
Address
402 Maple Avenue, Saratoga Springs, N Y 12866 .
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
. #
W
Permission is hereby granted to dispose of the human remains cribed aboy,e as indicate
Date Issued 02/25/2013 Registrar of Vital Statistics "'-
(signature)
District Number 4501 Place Saratoga Springs
I certify that the remains of the decedent identified.above were disposed of in accordance with this permit on:
k
tu Date of Disposition Z 71-13 Place of Disposition _�p.1yr,. Cr t oh-
2 (address)
Ili
>l
lc (section) 1 (lot number) (grave number)
Si'it'lliir
Name of Sexton or Pers n in Char a of PremisesC
Z (pl ase print)
10 RE Signature Title Ceti3,411 )7_
(over)
DOH-1555 (02/2004)