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Annesi, John F . - It lob NEW YORKSTATE DEPARTMENT OF HEALTH Burial -Transit Permit Bureau of Vital Records Name First Middle Last Sex John F Annesi Male Date of Death Age If Veteran of U.S.Armed Forces, 12/13/2021 88 Years War or Dates 1953-57 f.. Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ©Natural Cause ❑Accident EiHomicide I=1 Suicide El Undetermined El Pending W U Circumstances Investigation W Medical Certifier Name Title CI Abigail Macomber PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 602 ElBurial Date Cemetery,Crematory or Facility Name 12/16/2021 Pineview Crematory ElEntombment Address ElCremation Queensbury Town,New York ElDonation Z 0 Removal Date Place Removed and/or and/or Held H Hold Address N 0O. Date Point of U) 11 Transportation Shipment Q by Common Carrier Destination Date Cemetery Address ElDisinterment Date Cemetery Address 0 Reinterment Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above 2 Address CC ILl a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/15/2021 Registrar of Vital Statistics Robert Andrew Curtis(Electronically Signed) (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:r ~ Place of Disposition w r11-- 1l t ---_ W Date of Disposition �'Z���?/J p° (address) W Ce (section) //)lot number) (grave number/ 0 Name of Sexton or Person in Charge of P 'ses '`t �� Q (plea print) Z l� "Il Ili Title DOH-1555(07/18)p 1 of 2 015446 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#