Stutt, Robert L NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Biostatistics Vital Records Section
Name First Middle Last sex
Robert
Stutz
.... Louis
.... ... ...... .............. ..... ..... ............................. ...... ...... ............. ....... ......
Date of Death Age If Veteran of U.S.Armed Forces,
8/29/88 60
War or Dates
............. .....��s...... .........
Place of Death Hospital, Institution or
Street Address
.W� Cit Town or Village City of Glens Falls
..... .... . ....
...........................
:ji:il Cause of Death
cardiac dysrhythmic......................... ....... ......
2i Medical Certifier Name Title
.0 Robert Beat
.......... ..... ........ ....... .....
..........
Address
3 Irongate Center.,....Gle
.............. ................................
Death Certificate Filed District Number Register Number
City,Town or Village City of Glens Falls
Date Cemetery or Crematory
[--]Burial 9/2/88
Pine View Cremato
...........wm...... .............. ......... ......... .......
Cremation Address
Town of Queensbury, N.Y.
............ ....... .........................
Z. Date Place Removed
and/or Held
'0'. F1 Removal
........ ......... ........... .....
and/or Hold ..
".
Address
....................................................... ..... ........ ...... ...... ......... ...... .............................................................................. ....
Date Point of
F-]Transportation by .
Shipment
..........................................................................
Common Carrier ..... .....
Q:
Destination
............ ...... ...... .......... ............
...... Cemetery Address Date
... ❑ Disinterment
... .... ...................... ...... ..........CemeteAddress ..........
❑ Reinterment ry .
Date
Permit Issued to Registration Number
Name of Funeral Firm
-C...... ...... .......... ..Funer�al,.—Servi eq--Inc ...
................
Address
40 Quaker Road, Glens Falls, New York ...........
Name of Fun
eral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
.................... ...... .......... ......
&.............. .......... ...... .. ... ....... .......... ............
Address.
. . . . ............... ...
......... ..................... ....... .......... ...... .. ............. .............................. ...... .................................
Permission Is hereby granted to dispose of the huma rem a de4dribed ove as Indicated.
Date Issued Registrar of Vital Statistics (s nature)
C"Or
5�7
District Number Place .47
I certify that the remains of the decedent identified above were disposed!,40h accordance with this permit on:
Date of Disposition Place of Disposition LZ45�/y
W:
:2 (address)
Au.,
Wx'
(section) (lot number) (grave number)
oi
al: Name of Sexton or Person in Charge of Premises
Z (please print)
AU,
Signature Title
DOH-1555(9/86)p 1 of 2(formerly VS-61