D'Angelo, Eric Vincent g9-)
NEW YORK STATE DEPARTMENT OF HEALTH � Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Eric Vincent D'Angelo Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/14/2022 79 Years War or Dates
F. Place of Death Hospital,Institution or
Z City,Town or Village South Glens Falls Village Street Address 60 Main Street,South Glens Falls Village,New York 12803
IJJ
Manner of Death ❑X Natural Cause Accident ❑Homicide Suicide riUndetermined Pending
0 Circumstances Investigation
WMedical Certifier Name Title
Christopher Hoy MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Village Of South Glens Falls District Number Register Number
City,Town or Village 4524 11
Burial Date Cemetery,Crematory or Facility Name
® 11/15/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
Z❑Removal Date Place Removed
and/or and/or Held
N~ Hold Address
0
O. Date Point of
(I)OTransportation
CI Common Shipment
Carrier Destination
oDisinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
2 Address
CC
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/15/2022 Registrar of Vital Statistics Samantha Berg gkctronica(Signed)
(signature)
District Number 4524 Place Village Of South Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition tf I� 7L Place of Disposition s /
(address)
W
N
(section) �l (lot number) (grave number)
8 Name of Sexton or Person in Charge of Pre s t1 ti
Z (p se print)
W Signature Title
DOH-1555(07/18)p t of 2
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# :;