Cutter, Robert i' NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Robert CUTTER Dale
Date of Death Age If Veteran of U.S. Armed Forces,
01/02/15 66 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Albany Street Address
tilManner of Death 0 Natural Cause ❑Accident 0 Homicide 0 Suicide Undetermined Pending
tit Circumstances Investigation
tu Medical Certifier Name Title MD
0 Langdon
Address
DVAIVC 113 Holland Avenue, Albany, New York 12208
Death Certificate Filed Albany District Number Register Number
City, Town or Village Teter
gilgiBurial Date Cemet fior Crematory
❑Entombment /)a ��S 1 px\a r% S v S �'e_kM� f L--6
Address
;; ; ['Cremation 0 •- ti°e i•.s`t V c- 1 �
Date (Ia6e Removed
Z Removal and/or Held
fl ❑and/or
M Address
U)
Hold
O Date Point of
kE I Transportation Shipment
O by Common Destination
Ei Carrier
Q Disinterment I Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to D Baker Funeral HOme Registration Number
Name of Funeral HomeMaynard01130
Address
11 Tafayette St., Queensbury, New York
El Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
at
Iu
f` Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued cr,/'02/15 Registrar of Vital Statistics Janes Arrington
(signature)
District Number 198 Place DVAIC 113 Holland Avenue, Albany, New York 12208
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
to Date of Disposition 511zf/,►" Place of Disposition gyp, ,..e 5-/- Zit. ,+�'t
(address)
lit
D /G,3 e
re (secti loft number) (grave number)
• Name of Sexton rson in Charge of Premises f /4'�` , �- i It
�
z (please print)
W.
Signatur -----• - Title 4/01-4 /1/—/
(over)
DOH-1555 (02/2004)