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Cappella, Alan Christian ELF NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Per it Bureau of Vital Records Name First Middle Last Sex Alan Christian Cappella Male Date of Death Age If Veteran of U.S.Armed Forces, 01/30/2024 64 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Chester Town Warren Street Address 563 Landon Hill Road,Chester Town Warren,New York 12817 p Manner of Death El Natural Cause Accident Homicide Suicide Undetermined ri Pending Circumstances Investigation • Medical Certifier Name Title Robert Southerland MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Chester District Number Register Number City,Town or Village 5652 5 Burial Date Cemetery,Crematory or Facility Name 01/31/2024 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held Hold Address N 0 O. Date Point of ElTransportation a- by Common Shipment Carrier Destination Date Cemetery Address Disinterment n Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom _F Remains are Shipped,If Other than Above � Address CC a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/31/2024 Registrar of Vital Statistics Mindy Conway(E(ectronicatTy Signed) (signature) District Number 5652 Place Town Of Chester I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F W Date of Disposition Z 1 i 124 Place of Disposition Fro u S6 v riVAIIT!( 2 (address) W V) i= (section) n (lot number) (grave number) • Name of Sexton or Person in Charge o Premises r �'t O *ease(lease print) Z W Signature (�F�1M1Uc� Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) s` ' Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#