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Curri, Theta NEW YORK STATE DEPARTMENT OF HEALTH `: Vital Records Section Burial - Transit Permit Name First Middle Last Sex Theta S. Curri Female : Date of Death Age If Veteran of U.S. Armed Forces, January 13,2016 84 War or Dates I.., Place of Death Hospital, Institution or City, Town or Village Bolton Landing Street Address 167 Valley Woods Road ,cf° Manner of Death I I I I Undetermined Pending Natural Cause Accident Homicide Suicide L : Circumstances Investigation us Medical Certifier Name Title Shannon Evellis(Evens) PA Address Bolton Health Center,Bolton Landing,NY 12814 Death ficate Filed / District Number - Register Number City, own r Village 6(Z 6.57 ❑Burial Date Cemetery or Crematory January 18,2016 Pine View Crematory 0 Entombment Address ©Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed Z Removal and/or Held and/or Address H Hold N O Date Point of N Transportation Shipment p by Common Destination ill Carrier n Disinterment Date Cemetery Address Reinterment Date Cemetery Address -_ Permit Issued to Registration Number Name of Funeral Home Alexander-Baker Funeral Home 00037 Address 3809 Main Street,Warrensburg,NY 12885 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address ta Permission is hereb granted to dispose of the human remains descried ab e as indicated. Date Issued / C ti / Registrar of Vital Statistics ,I' (signature) District Number 5-4,�G) Place T/1' 4, / I, (Ay I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z 1' C c W Date of Disposition 1/10 f�b Place of Disposition �,4 u,;,..i t0..- W (address) N ct (section) A. (lot number) (grave number) pName of Sexton or Person in Char of Premises / r,,trk— Si t Z �y a(please print) w Signature G'L Title r/b4nt (over) DOH-1555 (02/2004)