Stutzer, Margaret NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
ng Name First Middle Last Sex
MargarEliz
abeth Stutzer
_::.:::.:. female....::.:
U.S. ,.
Date of Death Age If Veteran of .S.Armed Forces,
3 28 90 75 War or Dates no
Z Place of Death Hospital, Institution or
City,Town or Village Street Address
i!F Y 9 Town of Fort Edward Fort Hudson Nursing ,Home,:,::::..
W Manner of Death DI Natural Cause 0 Accident ❑Homicide 0 Suicide 0 Undetermined Pending
Circumstances Investigation
LU Medical Certifier Name Title
n Richard T. Hogan MD
Address
325 Main Street, Hudson Falls, N. Y 12839
Death Certificate Filed District Number Register Number
City,Town or Village Town of Fort Edward 5 75 5 /1- %s
Date CemeteryCrematory
or
IBurial 3/31/90 St Alphonsus_ Cemetery
Cremation Address
Queensbury New York
z Date Place Removed
O 0 Removal and/or Held
I- and/or Hold :::... ....::. ...: :: :.
Address
Cl)
O. ........ ............. .................. ...... ....
a Date Point of
N Ei Transportation by Shipment
.....
Destination
Disinterment Date Cemete Address
Reinterment Date Cemetery Address
Permit Issued to • Registration Number
Name of Funeral Firm Regan and Denny...Funeral.::Service,....Inc. 01.634.
Address
. 26:.Qua.ker...Road., .Queensbury, .:New::Y.o.rk:::.1.2.8.0.4 .......
f-. Name of Funeral Firm Making Disposition or to Whom
ig' Remains are Shipped, If Other than Above
WI
ii. Address
a:
Permission is hereby granted to dispose of the human remains described above as indicated.
igig Date Issued J' 34) - c?1,) Registrar of Vital Statistics t-k'-e- '• -0,--,1'
ignature)
District Number ,j 75-5"- Place ei',2- d< /'/'c'J'
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
12804
'W Date of Disposition 3/31 /9 0 Place of Disposition St. Alphonsus Cemetery, Luzerne Road, Oueensbury, NY
.2 (address)
w 3 grave section, Row 0, #23 So Half 2
Ncc (section) (lot number) (grave number)
p' Name of Sexton or Person in Charge of Premis Rev. Joseph A. Falletta
Z i / — I print)
w Signature , f c . Title Pastor
r�
DOH-1555 (10/89) p. 1 of 2 VS-61