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Harvanek, Andrew V
i.,„„C NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Andrew V.Harvanek Male Date of Death Age If Veteran of U.S.Armed Forces, 08/20/2023 50 Years War or Dates F. Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital LLI p Manner of Death IZI Natural Cause Accident El Homicide 0Suicide FlUndetermined riPending W Circumstances Investigation W Medical Certifier Name Title Q Todd Duthaler 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 479 Burial Date Cemetery,Crematory or Facility Name 08/22/2023 Pine View Crematory Entombment — Address ©Cremation Queensbury Town,New York Donation 0Z❑Removal Date Place Removed and/or and/or Held gHold Address Transportation Date Point f e by Common Shipment Carrier Destination Disinterment Date Cemetery Address pReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above IAddress CL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/22/2023 Registrar of Vital Statistics Dilton Moran(ECectronica1Ty Signed) (signature) •`"I 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 WDate of Disposition f IZK/L3 Place of Disposition f'_, L.. Z 2 (address) W NCC (section) i7(lot number) (grave number) 8 Name of Sexton or Person in Charge of Premises n• L_._ I1- Z (....„,, (pi se print) LU Signature Title (� .r►1q(liiC DOH-1555(07/i8)p 1 of 2 21 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#