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Kasitch, Brett L NEW YORK STATE DEPARTMENT OF HEALTH LF) Burial- Transit Permit Bureau of Vital Records \., J,.Y Name First Middle Last Sex Brett L Kasitch Male Date of Death Age If Veteran of US.Armed Forces, 01/11/2024 60 Years War or Dates 1982-84 i.,. Place of Death Hospital,Institution or W City,Town or Village Corinth Town Street Address 31 Gabriel Road,Corinth Town,New York 12822 0 Manner of Death IX Natural Cause ❑AccidentI:I Homicide 0Suicide Undetermined Pending W Circumstances Investigation 0 Medical Certifier Name Title John Pezzulo DO Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed Town Of Corinth District Number Register Number City,Town or Village 4553 2 Burial Date Cemetery,Crematory or Facility Name ..." 01/13/2024 Pineview Crematory Entombment _ Address ©Cremation Queensbury Town,New York EiDonation ❑Removal Date Place Removed and/or and/or Held N Hold Address O O. Date Point of CO❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above 2 Address CC lW a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/12/2024 Registrar of Vital Statistics Brenda L Penis(Electronically Signed) (signature) District Number 4553 Place Town Of Corinth I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F,Je 14 ,/ re si. W Date of Disposition �1j��`% Place of Disposition � ��. address/ W U) OC (section). (lot n mber /grave number) Name of Sexton or Person in Charge of P 'ses I``tiferi b /lewd Z , (please print) W Signature Title Qf(1?zi DOH-1555(07/18)p 1 of 2 4 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#