Cuthrell, Mary 11.1.1
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
r4 Name First Middle Last Sex
Ma Lu Cuthrell Female
t Date of Death Age If Veteran of U.S. Armed Forces,
ue" 08/01/2017 83 Years War or Dates
Place of Death Hospital, Institution or
i City, Town or Village Glens Falls Street Address Glens Falls Hospital
'1 Manner of Death j Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined El❑Pending
k. Circumstances Investigation
, Medical Certifier Name Title
? Mathew Varughese DO
Address
ti
100 Park St,Glens Falls,New York 12801
�,`; Death Certificate Filed District Number Register Number
• City, Town or Village Glens Falls 5601 417
❑Burial Date Cemetery or Crematory
Al 08/03/2017 Pineview Crematory
❑Entombment Address
Cremation Quuensbury, New York
XI
Date Place Removed
❑Removal and/or Held
.1 and/or Address
k':' Hold
Date Point of
uxt ❑Transportation Shipment
by Common Destination
• F; Carrier
❑Disinterment
Date Cemetery Address
'r Date Cemetery Address
• ❑Reinterment
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
r Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/03/2017 Registrar of Vital Statistics qo6enA Claus cE(ectranicaffysigned-
(signature)
img
• District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition (`3/17 Place of Disposition ,P,)7QJreA,(1 C,/e-a 7r*y
(address)
(section) (lo number) (grave number)
Name of Sexton P n in Charge of Premises 3 i c 441 �
(please print)
• Signature ✓ Title Z—
(over)
DOH-1555 (02/2004)