Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Marcantonio, Matthew John
1 Y)2 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Matthew John Marcantonio Male Date of Death Age If Veteran of U.S.Armed Forces, 04/22/2023 42 Years War or Dates Place of Death Hospital,Institution or isiZ City,Town or Village Fort Ann Town Street Address 15 West Road,Fort Ann Town,New York 12827 Manner of Death ❑Natural Cause Accident ITI Homicide 0Suicide nUndetermined Pending WCircumstances Investigation u,( Medical Certifier Name Title el Robert Lemieux Coroner Address 415 Lower Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed Town Of Fort Ann District Number Register Number City,Town or Village 5754 7 Burial Date Cemetery,Crematory or Facility Name 04/25/2023 Pine View Crematory Entombment — Address ©Cremation Queensbury,New York Donation 2 El Removal Date Place Removed and/or and/or Held Hold Address Date Point of N❑Transportation Shipment a by Common Carrier Destination Disinterment Date Cemetery Address �.O Reinterment Date Cemetery Address N =; Permit Issued to Registration Number a Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom t� Remains are Shipped,If Other than Above 2 Address 1 IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/24/2023 Registrar of Vital Statistics Miranda 7ferrings(iaw(E(ectronica((y Signed) (signature) . District Number 5754 Place Town Of Fort Ann I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition H�15"I t3 Place of Disposition .1 ,/a dress) W cc (section) (lot number) (grave number) st:.4 zName of Sexton or Person in Ch f Premises A"�L 1 ii / (please print) W Title Ir FiYh"irlyz Signature DOH-1555(07/18)p 1 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#