D'Andrea, Louis A NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Louis A.D'Andrea Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/16/2022 93 Years War or Dates 1953-1955
E Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address 55 Hickock Road, Saratoga Springs, New York 12833
ILI
p Manner of Death EINatural CauseAccident nHomicide OSuicide Undetermined ❑Pending
O Circumstances Investigation
LU Medical Certifier Name Title
Robert Love MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed City Of Saratoga Springs District Number Register Number
City,Town or Village 4501 426
BurialE
Date Cemetery,Crematory or Facility Name
07/18/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
d Date Point of
Cl)❑Transportation
p by Common Shipment
Carrier Destination
ElDisinterment Date Cemetery Address
EiReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Brewer Funeral Home Inc 00211
Address
24 Church Street PO Box 500, Lake Luzerne, New York 12846
Name of Funeral Firm Making Disposition or to Whom
H. Remains are Shipped,If Other than Above
5 Address
CC
W
0-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/18/2022 Registrar of Vital Statistics Dillon Moran(Electronically Signed)
(signature)
District Number 4501 Place City Of Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
Z Z Date of Disposition 111 sal Place of Disposition 'gatVt., (i d!....._
111
2 (address)
W
N
M (section) ` (lot number) S, (grave number)
0
Name of Sexton or Person in Charge of Pre ises 1" etnt)
Z
w 0" r21
Signature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on ,' i , 20
Pine View Cemetery Representing the funeral home named on butial permit
Official Funeral Directors Reg.or License#