Sauter, Richard is
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Richard R. Sauter Male
Date of Death Age If Veteran of U.S. Armed Forces,
10/20/2018 75 War or Dates 1963-1967
Place of Death Hospital, Institution or
City, Town or Village Town of Queensbury,NY Street Address 128 4th Street,Queensbury,NY
itt Manner of Death n Natural Cause n Accident Homicide E Suicide n Undetermined n Pending
ijaCircumstances Investigation
a Medical Certifier Name Title
a` John Stoutenburg MD
Address
102 Park St.Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
) City, Town or Village Town of Queensbury NY OC.- 1
P1 Burial Date Cemetery or Crematory
October 27,2018 Pine View Cemetery
❑Entombment Address
❑Cremation Quaker Road,Queensbury,NY 12804
Date Place Removed
ZZ U Removal and/or Held
and/or Address
H Hold
N
o Date Point of
N C Transportation Shipment
p by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
Ot
W;
gt, Permission is hereby granted to dispose of the human re ains described a• •ve as indicated.
Date Issued 10 t 0-,4/cd01 , Registrar of Vital Statistics �__Q , ' .,.,
(signature)
District NumbeeLo Place I O c_s—r, Q (f) LA
I certify that the remains of the decedent identified above were disposed of i accorda ce with this permit on:
Z
lL Date of Disposition 1 0/27/201 Place of Disposition pine View Cemetery Oueensbury NY
2 (address)
W
U) Seneca 2-H 1
re (section) (lot number) (grave number)
pName of Sexton or Person in Charge of Premises Connie L. Goedert
Z 041.4A:t4
,p , /� (please print)
W Signature w Q cLed Title Cemetery Superintendent
9
(over)
DOH-1555(02/2004)