Hutnik, Joseph s
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
R Name First Middle Last Sex
:f�r,'r
Joseph Edward Hutnik Male
r Date of Death Age If Veteran of U.S. Armed Forces,
'.:A... July 30, 2016 92 War or Dates World War II
iPlace of Death Hospital, Institution or
City, Town or Village Moreau Street Address Home Of The Good Shepherd-Moreau
Manner of Death
X Natural Cause I J Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
rr./ Eric A. Goe Dr.
,-,4Address
65 Elm Street,Glens Falls,NY 12801
Death Certificate Filed District Nu m gi t
r Reei Number
: City, Town or Village Moreau �S .P
❑Burial Date Cemetery or Crematory
❑Entombment 08/01/2016 Pine View Crematorium
Address
❑x Cremation 51 Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
O, and/or Address
H Hold
Cl)
0 Date Point of
IL
N Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
:, Permit Issued to Registration Number
r Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury, NY 12804
r0 Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby ranted to dispose of the human remai s crib ab ve as indicated.
r
'jj: Date Issued 0 $ 0 i / Registrar of Vital Statistics
''f
(si nature) ]y l Q
District Number / 9D.., Place ( 0 ATV Id d d/ MOY0011, ,(f k, d�O
} I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
, Date of Disposition 434>� Place of Disposition vV1t,,J (�,,,a-4r—'
Ili ?AM, (address)
tO
tr
(section) lat."
number) (grave number)
Z
Name of Sexton or Person in Charge of Premisestoar
W ( print)
Signature 4 Title cOMA T)(t
(over)
DOH-1555(02/2004)