Hutsteiner, Florrie NEW YORK STATE DEPARTMENT OF HEALTH'
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
FLORRIE HUTSTEINER Female
Date of Death Age If Veteran of U.S. Armed Forces,
April 14, ,21017 101 -War or Dates n/ ,
}- Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address The Pines of Glens Falls
Manner of Death !! Natural Cause ❑Accident ❑Homicide 0 Suicide ri❑Undetermined ❑Pending
tii Circumstances Investigation
ill Medical Certifier Name Title
Address
Death Certificate Filed District Numh. Register Number
City, Town or Village Glens Falls, ,NY 56C
❑Burial Date Cemetery or amatory
April 17, ,2017 Pine aw Cr. :iatory
:: :DEntombment Address
®Cremation Quaker Road Queensbury„NY 1 U4
Date Place Rer ,ved
Z Removal and/or He
❑and/or Address�,;;
it,
Hold
0 Date Point of
CL
D Transportation Shipment
C by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
qii Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford 01443
Address
53 Quaker Road Queensbury„NY 12804
Mi Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
IX
a` Permission is hereby granted to dispose of the human remains described/ abb000 e a • icated.
Date Issued 4//6/ 017 Registrar of Vital Statistics ,AcA/ lOL-`G,
(signature)
District Number 5 O/ Place City of Glens Falls, ,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I
��>� Date of Disposition '��/�/� Place of Disposition /` /7� eV r�) �-6l�
/ (address)
ttit
CC (section) (lot n mber) (grave number)
ci j
Name of Sexton or rson i Charge of Premises LA- /( -K 6 7Il'z 4-C'ItJ
e (please print)
E Signature i Title Gee- Yn w
(over)
DOH-1555 (02/2004)