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Pacher, Denise Louise
NEW YORKSTATE DEPARTMENT OF HEALTH Burlap - Transit Permit Bureau of Vital Records Name First Middle Last Sex Denise Louise Pacher Female Date of Death Age If Veteran of U.S.Armed Forces, 12/24/2019 54 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Mannerof Death ©Natural Cause Accident Homicide Suicide Undetermined Pending W V Circumstances Investigation 0 Medical Certifier Name Title Gamal Khalifa MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 551 Burial Date Cemetery,Crematory or Facility Name 12/27/2019 Pine View Crematorium Entombment Address 0 Cremation Queensbury Town,New York Donation 0 ❑Removal Date Place Removed and/or and/or Held H Cl) Hold Address O d Date Point of fAElTransportation C] by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition orto Whom Remains are Shipped,If Other than Above Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/26/2019 Registrar of Vital Statistics W96ert,4ndrew Curtis(ErectronicalTy Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F- W Date of Disposition Place of Disposition so 2 (ad ss) W CAI IIr (section) (lotnumb/er) (grave number) Name of Sexton or Person in Charge of Pre is s N oo c' Z (please print) Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) y_ 10 1 3 1 8 a Receipt Human remains of % f- delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# f!