Amatuzzi, Annunziato NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Annunziato Amatuzzi Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/03/2023 73 Years War or Dates
1:.i Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital
Ill
CI W Manner of Death 0Natural Cause Accident 0 Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
Q Romel Gobunsuy MD
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 91
Burial Date Cemetery,Crematory or Facility Name
02/07/2023 Pine View Crematory
Entombment Address
EICremation Queensbury Town,New York
Donation
Z❑Removal Date Place Removed
and/or and/or Held
H Hold Address
0
0
Date Point of
Cl)❑Transportation Shipment
p by Common
Carrier Destination
DDisinterment Date Cemetery Address
ElReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
1.- Remains are Shipped,If Other than Above
g Address
CC
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/06/2023 Registrar of Vital Statistics DilfanWoran(cECectronicaf( 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: / f
Z Date of Disposition 2 j%123 Place of Disposition `I ^^L
W (address)
W
NCC (sea/on) A (lot number) (grave number)
::::: °"
or Person in Charge of P .4reit
re Title / y '' r�
DOH-1555(07/18)p 1 of 2
F "' .!
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#