Cutler, Dorothy NEW YORK STATE DEPARTMENT OF HEALTF i 4 ` s i
Vital Records Section Burial Transit Permit
Name First Middle Last Sex
Dorothy Constance Cutler Female
Date of Death Age If Veteran of U.S. Armed Forces,
September 5, 2012 86 War or Dates
Z Place of Death Hospital, Institution or
IliCity, Town or Village Fort Edward Street Address Apt 32, The Oaks
Ci Manner of Death Natural Cause 0 Accident E Homicide Ei Suicide ElUndetermined El Pending
U l
Circumstances Investigation
W Medical Certifier Name Title
Q, Craig A Emblidge MD,
Address
3 Irongate Center Glens Falls, NY 12801
Death Certificate Filed District Number Register f§ tuber
t City, Town or Village ?�Z`�
❑Burial Date Cemetery or Crematory
September 7, 2012 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date ' Place Removed
z Removal and/or Held
and/or Address
} Hold
Date Point of
Transportation Shipment
(1) by Common Destination
E, Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
F— Remains are Shipped, If Other than Above
2 Address
LU
Permission is h re granted to dispose of the human ajns described bove s indicated.
Date Issu Registrar of Vital Statistic2 f:,
/ (signature)
District Numbe575S Place—✓
—' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition 9-1'I1_ Place of Disposition Pi At') '141'
2 (address)
WOt CO
(section) lot number) 1 (grave number)
a` Name of Sexton or Per on in Charg of Premises Algirl,►
� r
Z (p ase print)
W Signature Title _ e NNIVIC
(over)
DOH-1555 (02/2004)