Bacchi, Angela Rose LF
5�2
NEW:ORKSTPrTE DEPARTMENT OF HEALTH 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
Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital
W
p Manner of Death Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
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
Burial Date Cemetery,Crematory or Facility Name
12/08/2022 Pine View Crematory
Entombment _Address-- — -
[JElCrern-i on "QueensburyTowri,'NewYork - - --_- — --- —:
Donation
Z❑Removal Date Place Removed
O and/or and/or Held
~ Hold Address
CO)
O
'-
(A Transportation Date Point of
p by Common Shipment
Carrier Destination
❑Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
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 Otherthan Above
2 Address
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/07/2022 Registrar of Vital Statistics DM*nM,,-.n(Ek tronkaLySim7ed)
(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:
H
Z Date of Disposition z g1 ZZ Place of Disposition �;�
W
2 1 (address)
W
cc (section/_ (/ot�mberl {�(grave number)
Name of Sexton or Person in Charge of Pr ises s' `I
Z (ple a print/
W Signature Title
DOH-1555(07/18)p 1 of 2
016470
Public Health Law Sec. 4145(2b)
i
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official I; Funeral Directors Reg. or License