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Caputo, Cynthia NEW YORK STATE DEPARTMENT OF HEALTH = . L, it 70„ Vital Records Section Burial - Transit Permit Name First Middle Last Sex Cynthia M. Caputo Female }F Date of Death Age If Veteran of U.S. Armed Forces, August 26, 2018 61 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 ❑ Undetermined ❑ Pending Circumstances Investigation Medical Certifier Name Title Amy Hogan-Moulton, M.D. Dr. Address 2 Broad Street Glens Falls, NY 12801 Death Certificate Filed District Number ' Register Number `' I City, Town or Village Glens Falls ❑Burial Date Cemetery or Crematory August 30, 2018 Pine View Crematory ❑Entombment Address a,©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed ❑ Removal and/or Held and/or Address Hold Date Point of ❑Transportation Shipment by Common Destination Carrier ., Date Cemetery Address - + ❑ Disinterment ElReinterment Date Cemetery Address ,`` Permit Issued to Registration Number Name of Funeral Home M. B. Kilmer Funeral Home-FE 01079 Address 82 Broadway, Fort Edward NY 12828 Name of Funeral Firm Making Disposition or to Whom 1-.; Remains are Shipped, If Other than Above . Address Permission is hereby ranted to dispose of the hums remains scribed a ove as indi ated Date Issued __ Registrar of Vital Statistics e—(,_/-7,--1-2 . AAiic ra........e.6 (signs ure) District Number plc) / Place 7 l I certify that the remains of the decedent identified above were disposed of in accordant with this permit on: Date of Disposition 08/30/2018 Place of Disposition Quaker Road Queensbury,NY 12804 (address) (section) (lot number (grave number) Name of Sexton or Person in Charge of Premises �+Irsl+ le ��'� lease print) Signature t( Title ( ern r i - (over) DOH-1555 (02/2004)