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Martucci, Christine NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit - Name First Middle Last Sex Christine A Martucci Female Date of Death Age If Veteran of U.S.Armed Forces, 03/22/2018 60 Years War or Dates YO Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause ❑Accident II Homicide ❑Suicide ❑Undetermined El❑Pending Circumstances Investigation Medical Certifier Name Title _ .1 Gamal Khalifa MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed1 District Number Register Number City, Town or Villa•e Glens Falls 5601 147 `❑Burial Date I Cemetery or Crematory £'' 03/23/2018 Pine View Crematory El Entombment Address ®Cremation Queensbury, New York Date Place Removed ❑Removal and/or Held . .-� and/or Address Hold Date Point of 1 ❑Transportation Shipment µ ;. by Common Destination Carrier ❑Disinterment Date I Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number 6 Name of Funeral Home Regan Denny Stafford Funeral H.me 01443 _' Address if 53 Quaker Rd,Queensbury,New York 12804 LI Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address ,, Permission is hereby granted to dispose of the human remains described above as indicated. = Date Issued 03/23/2018 Registrar of Vital Statistics Wp6ertA Curtis(ECectronica1Ty 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: Tr Date of Disposition 3J14►1Ig Place of Disposition 1411_, 4.-4_,, !1 (address) H 4 (section) GL^ (lot numb (grave number) Name of Sexton or Person in Charge of Premises As.-+4'( ,-� q( lease print) rrt. Signature el 4 Title fr mDNA (over) DOH-1555(02/2004)