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Boutelle, Laurie J.
it 700 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Laurie J Boutelle Female Date of Death Age If Veteran of U.S.Armed Forces, 02/19/2021 62 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital IiJ Manner of Death W1=1 1=1Undetermined Pending©Natural Cause Accident Homicide Suicide Circumstances Investigation W Medical Certifier Name Title CI Eileen Spinelli NP Address Carey Rd,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 105 ElBurial Date Cemetery,Crematory or Facility Name 02/22/2021 Plneview Crematory ❑Entombment Address 0 Cremation Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held N Hold Address 0 d Date Point of co Li Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom — Remains are Shipped,If Other than Above 2 Address Q uJ a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/22/2021 Registrar of Vital Statistics Robert Andrew Curtis(Electronically Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ' _A Z Date of Disposition � 1Z�'Zf Place of Disposition ,` (J1 (address) W CC CC (section) pot mber) (grave number) 0 Name of Sexton or Person in Charge of P .ses �'' vNe�yl� Z (please prin) 4- lL Signature Title ! -W h47 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) tj 1 4 5 6 7 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funer Reg.or License#