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D'Angelico, Shawn Michael . ‘c__,...F-\ wc,39 . ...., NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Shawn Michael D'Angelico Male Date of Death Age If Veteran of U.S.Armed Forces, 08/26/2023 36 Years War or Dates F_ Place of Death Hospital,Institution or W City,Town or Village Mount Pleasant Town Street Address Westchester Medical Center p Manner of Death Ei Natural Cause []Accident El Homicide 0Suicide FlUndetermined ❑Pending W U Circumstances Investigation W Medical Certifier Name Title CI Katiana Philippe Address 100 Woods Road,Mount Pleasant Town,New York 10595 Death Certificate Filed Town Of Mount Pleasant District Number Register Number City,Town or Village 5957 602 R Burial Date Cemetery,Crematory or Facility Name 08/28/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Z❑Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 O. Date Point of Cl)❑Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 5 Address CC W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/28/2023 Registrar of Vital Statistics Emily Costanza(ElectronicalySignei (signature) District Number 5957 Place Town Of Mount Pleasant I certify that the remains of the decedent identified above were disposed of in accordance with this permit+ on: I Z Date of Disposition g-Z9Zo13 Place of Disposition 6 iJ e V/, �e L�y+444o 1` `1 W (address) ILL' NCC (section) (lot number) 1 (grave number) O• Name of Sexton or Person in Charge of Pre ses j�j p �/ iV ��d CI (ple�ase print) W Signature Title 0� 4j'`,"�► 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#