Bacchi, Angela Rose s a V__
NEW YORK STATE DEPARTMENT OF HEALTH (-111) Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Angela Rose Bacchi Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/07/2022 68 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Saratoga Springs Street Address Saratoga Hospital
0 Manner of Death Ei Natural Cause Accident Homicide DSuicide FlUndetermined El Pending
W Circumstances Investigation
W Medical Certifier Name Title
O Maria Vivenzio DO
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed City Of Saratoga Springs District Number Register Number
City,Town or Village 4501 718
HBurial Date Cemetery,Crematory or Facility Name
12/08/2022 Pine View Crematory
Entombment Address
▪Cremation Queensbury Town,New York
▪Donation
ZO❑Removal Date Place Removed
and/or and/or Held
F- Hold Address
N
0
Date Point of
(I)❑Transportation Shipment
Q by Common
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
❑Reinterment
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077
Address
123 Main St,Argyle,New York 12809
Name of Funeral Firm Making Disposition or to Whom
i— Remains are Shipped,If Other than Above
5 Address
CC
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/07/2022 Registrar of Vital Statistics DiZa Moran gkctronicalTySigned)
(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—
�
�
W NI of Disposition )z � aPlace of Disposition 'l i�V.—
""t�
(address)
CCW ,
(section) A ( e(lotgumber) (grave number)
00 Name of Sexton or Person in Chargeprint/z rl ar01(
W Signature Title
..:
DOH-1555(o7/18)pi of 2
01 470
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# a