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Sticht, Cathleen D. # i9c • NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital.Records Name First Middle Last Sex Cathleen D Sticht Female Date of Death Age If Veteran of U.S.Armed Forces, 02/12/2021 71 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Albany Street Address Albany Medical Center Hospital Manner of Death Undetermined Pending W ©Natural Cause 0 Accident Homicide Suicide Circumstances Investigation W Medical Certifier Name Title O John Lewis Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 0550 Burial Date Cemetery,Crematory or Facility Name 02/19/2021 Pineview Crematory ❑Entombment Address 0 Cremation Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held H Hold Address N 0 d Date Point of co Li Transportation by Common Shipment Carrier Destination El 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 F.. Remains are Shipped,If Other than Above 2 Address W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/19/2021 Registrar of Vital Statistics Danielle S Gillespie(Electronically Signed) /signature) District Number 0101 Place Albany, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: lr Z Date of Disposition o1-21:2— / Place of Disposition (32-„ -e- V 4� C (� c/ress) W CC CC (section) �> ,/, (lot number) (grave /grave number) aName of Sexton or Person in Charg of Premises F�N7'1y1�r"�� n��t�'' Z (please print) 11.1 Signature ? X7 Title 0 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 01_ 5 6 2 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#