Mitchell, Anthony 1 s # V?I
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Anthony Mitchell Male
Date of Death Age If Veteran of U.S.Armed Forces,
08/06/2021 69 Years War or Dates
H Place of Death Hospital,Institution or
W City,Town or Village Albany Street Address Albany Medical Center Hospital
0 Manner of Death ❑X Natural Cause ❑Accident El Homicide J Suicide ❑Undetermined 0 Pending
W Circumstances Investigation
U F
W Medical Certifier Name Title
G Milanka Stevanovic
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 1992
El Burial Date Cemetery,Crematory or Facility Name
08/10/2021 Pine View Crematory
ElEntombment Address
gCremation Queensbury Town,New York
ElDonation
Z ❑Removal Date Place Removed
and/or and/or Held
F- Hold Address
N
0
Date Point of
(p 0 Transportation Shipment
Q by Common
Carrier Destination
Date Cemetery Address
❑Disinterment
Date Cemetery Address
❑Reinterment
Permit Issued to Registration Number
Name of Funeral Home Regan&Denny Funeral Service 01444
Address
94 Saratoga Ave,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
" Address
CIC
O.▪.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/09/2021 Registrar of Vital Statistics DDanielleScillegrie glectronicall Signea9
(signature)
District Number 0101 Place Albany, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition it 0 fit.( Place of Disposition
W (address)
W
ir (section/ (tot number) (grave number)
GName of Sexton or Person in Charge of Pre ises C�r '' St~~�
Z (pte e print) LlM
W Signature Title 1`� ryl�
f; 74 :�
DOH-1555(o7/18)p 1 of 2
Public Health Law Sec. 4145(2b) 1
Receipt
Human remains of _ delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#