Dudas, Otto 'c'-4 \cLIN „
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
:a :: Name First Middle Last Sex
Otto Dudas Male
r:::„ Date of Death Age If Veteran of U.S. Armed Forces,
:d:: March 3, 2014 77 War or Dates
ig Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
gi Manner of Death X Natural Cause I I Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
R: David Cunningham
Address
3 Irongate Center,Glens Falls,NY 12801
:6 Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 i 0 )
❑Burial Date Cemetery or Crematory
March 5, 2014 Pine View Crematorium
❑Entombment Address
❑x Cremation 21 Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
F_ Hold
N
0 Date Point of
yTransportation Shipment
(3 by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
:i'i Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
: : 53 Quaker Road, Queensbury,NY 12804
ram Name of Funeral Firm Making Disposition or to Whom
�1 Remains are Shipped, If Other than Above
Address
St
�:; Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 3 1 S ) 1 9 Registrar of Vital Statistics L1\.)C.. .Z W.
(signature
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 3J4114 Place of Disposition '(, ry ackw,
2 (address)
W
U)
re (section) d (lot numbe (grave number)
O• Name of Sexton or Person in Char of Premises 4
J ^wit
Z (please print)
ut Title
Signature reitarr I ,
(over)
DOH-1555(02/2004)