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Desantis, Michael Eugene # 5� NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Michael Eugene Desantis Male Date of Death Age If Veteran of U.S.Armed Forces, 11/13/2021 60 Years War or Dates 1982-1985 Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death © Natural Cause ❑Accident ❑ Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title 0 Scott Biasetti MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 507 ❑Burial Date Cemetery,Crematory or Facility Name 11/15/2021 Pine View Crematory ❑Entombment Address ▪Cremation Queensbury Town,New York ❑Donation O❑Removal Date Place Removed and/or and/or Held H Hold Address 0 a Date Point of U) ❑Transportation p by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Addre;s Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls, New York 12803 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above T Address ILI 0- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/14/2021 Registrar of Vital Statistics `pert Andrew Curtis(EfectronicaCCySigned) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H � Z Date of Disposition �j�l j�Z) Place of Disposition �I InA IL Ad� (address) W CC (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge Premises 4 r�� �'+'�+� Z (plea e print) lL Signature Title Cr"' DOH-1555(07/18)p 1 of 2 1 _ ., , Public Health Law Sec. 4145(2b) ' Receipt Human remains of delivered on ' _ , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#