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Andreadakis, Thomas D
. t M1 N EW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Thomas D.Andreadakis Male Date of Death Age If Veteran of U.S.Armed Forces, 02/19/2024 79 Years War or Dates -1964-1966 i_ Place of Death Hospital,Institution or Z City,Town or Village Ballston Spa Village Street Address 348 Milton Avenue Apt B,Ballston Spa Village,New York 12020 W p Manner of Death �NaturalCause []Accident []Homicide []Suicide []Undetermined []Pending W (Circumstances I 'Investigation W Medical Certifier Name Title CI Yasmin Mohamed DO Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed Village Of Ballston Spa District Number Register Number City,Town or Village 4520 5 IIIBurial Date Cemetery,Crematory or Facility Name 02/20/2024 Pine View Crematory []Entombment Address ©Cremation Queensbury Town,New York Donation O[]Removal Date Place Removed and/or _ _ and/or Held H Hold Address N 0 d Date Point of Cl)OTransportation p by Common Shipment Carrier Destination []Disinterment Date Cemetery Address []Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home William J Burke&Sons Funeral Home 01827 Address 628 N Broadway,Saratoga Springs,New York 12866 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/20/2024 Registrar of Vital Statistics Teri Gee OConnor(ECectronicaCCySigned) (signature) District Number 4520 Place Village Of Ballston Spa I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: l— Z Date of Disposition Z 111 Iz9 Place of Disposition f'j ii vs‘I-) G04thteavr..rti-..., 2 (address) W Cl) CC (section) i(lot number) (grave number) Name of Sexton or Person in ChargQ r mises ! t,0 L e'r (plese print) Z j W Signature Title l �1��?l� DOH-1555(07/18)p 1 of 2 T 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#