Curto, Nicholas NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
f Name First Middle Last Sex
IINicholas F Cutro, !male
Date of Death
:<ff: Age If Veteran of U.S. Armed Forces,
`: November 3, 2016 80 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death ❑Natural Cause Accident Homicide ❑Suicide n Undetermined Pending
g
Circumstances Investigation
Medical Certifier Name Title
Jennifer Stratton Dr.
pg Address
::: 161 Carey Rd.,Queensbury,NY 12804
ei
's Death Certificate Filed District Number Register Number
=< City, Town or Village Glens Falls 5601
❑Burial Date Cemetery or Crematory
November 7, 2016 Pine View Crematory
❑Entombment Address
Ei Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z n Removal _ and/or Held
O and/or A .s
H Hold
CO
0 9 Point of
NI-1 Transportation Shipment
p by Common nation
Carrier
Disinterment Da-e Cemetery Address
pi Reinterment Date Cemetery Address
Permit Issued to Registration Number
fr< Name of Funeral Home Regan Denny Stafford Funeral Home 01443
0 Address
r>>, 53 Quaker Road, Queensbury, NY 12804
?,rl,
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address 1Jl:?`' Permission is hereby granted to dispose of the human remains described above as indicated.
..__ Date Issued I i I `7 120) , Registrar of Vital Statistics -e l.� � \i
_:: (signature
:in District Number 5601 Place Glens Falls, ki
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition /jig ig, Place of Disposition
W (address)
CO
p0 (section) //�� (lot number) C (grave number)
Name of Sexton or Person in Charge of Premises `�ns v �+i(r
Z /� ( lease print)
W Signature (.� �F•rC. Title Ck.MjX
(over)
DOH-1555(02/2004)