Boettcher, Fritz NEW YORK STATE DEPARTMENT OF HEALTH .-- ?ag
Vital Records Section Burial - Transit Permit
Name First Middle `" Last Sex
FRITZ KURT BOETTCHER Male
Date of Death Age If Veteran of U.S. Armed Forces,
10-27-2016 95\. War or Dates
Place of Death ~ • Hospital, Institution or
it City, Town or Village Schenectady Street Address 1 771 Randolph Road
WW Manner of Death 0 Natural Cause ❑ Accident 0 Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
W Medical Certifier Name Title
C3 Chester Burton MD
Address
132 MacArthur Ave. , Cobleskill, NY 12043
Death Certificate Filed � � District Number ' 0 Register Nu er
City, Town or Village 1I
❑Burial Date Cemetery or Crematory V
10-28-2016 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
z ❑ Removal and/or Held
and/or Address
F. Hold
5' Date Point of
ci. n Transportation Shipment
CO by Common Destination
a Carrier
Date Cemetery Address
E Disinterment
Date Cemetery Address
❑ Renterment
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
68 Main Street, Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
F_ Remains are Shipped, If Other than Above
M Address
CC
W
a" Permission is h reby ranted to dispose of the human remain d • -cribe abov:�/-y indi to i.
Date Issued l,, Registrar of Vital Stati tics A, A 4 UJ Cam , Ii ', lit
I(signature)
District Number LI C pfq ( Place a
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition /03/ //b Place of Disposition en./d .-, rvytvol-2•_
W (address)
0'_
ce (section) (loi number) cc (grave number)
LAY Name of Sexton or Person in Charge of Premises l(r‘qopLivi Jtwitti
W (please rint)
Signature �� • Title 0 M 0 _
(over)
DOH-1555 (02/2004)