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Dutcher, Bernard NEW YORK STATE DEPARTMENT OF HEALTH i ` ` -6 itit? Vital Records Section Burial - Transit Permit Name First Middle Last Sex Bernard Melvin Dutcher Male Date of Death Age If Veteran of U.S. Armed Forces, February 23, 2017 73 War or Dates .. Place of Death Hospital, Institution or in City, Town or Village Hudson Falls Street Address 9 Baker Street Manner of Death Natural Cause ❑ Accident El Homicide ❑ Suicide ❑ Undetermined ❑ Pending U, L. Circumstances Investigation W Medical Certifier Name Title W Michael Fuller, Dr. Address 100 Park Street Glens Falls, NY 12801 Death Certificate Filed District Number Register Number City, Town or Village Hudson Falls s7/(o ❑Burial Date Cemetery or Crematory February 27, 2017 Pine View Crematory il❑Entombment Address �d; ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed Z ❑ Removal and/or Held O and/or Address • Hold L Date Point of d ❑Transportation Shipment O by Common Destination ❑ Carrier Date Cemetery Address ❑ Disinterment Date Cemetery Address El Reinterment Permit Issued to Registration Number Name of Funeral Home M. B. Kilmer Funeral Home-Argyle 01077 Address 123 Main St., Argyle NY 12809 Name of Funeral Firm Making Disposition or to Whom t Remains are Shipped, If Other than Above X Address CK Permission is hereby granted to dispose of the human remains scribed above as indicated. Date Issued -9,(-1- a0, 7 Registrar of Vital Statistics `I _ (signature) District Number 51 g\( Place y� Q 4 ti -L I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: .Z" ' w Date of Disposition 02 /2017 Place of Disposition Quaker Road Queensbury,NY 12804 P/7/Qufn,,,IL/efr;�-c471r../ (address) IL (section) \ I (lot mber) (grave number) • Name of Sexton e o in Charge of Premises 1 1/1' /( ��'L �2�? ��G he ►; (please print) W Signature Title C rei-,mot 4 ef-- -' (over) DOH-1555 (02/2004)