Cutcher, Julie K ILFNEW YORKSTATE DEPARTMENTOF HEALTH ` -,._._- ' Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Julie K.Cutcher Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/19/2022 61 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Warrensburg Town Street Address 29 Balsam Crest Lane B,Warrensburg Town,New York 12817
`p Mannerof.Death II Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
Suzanne Bergin DO
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Warrensburg District Number Register Number
City,Town or Village 5660 18
Burial Date Cemetery,Crematory or Facility Name
""1 10/22/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
OElRemoval Date Place Removed
and/or and/or Held
- Hold Address
0
0. Date Point of
Cl)EITransportation
p by Common Shipment
Carrier Destination
EDisinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped,If Other than Above
Address
CIC
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/21/2022 Registrar of Vital Statistics Tame&aIM Lloyd(ECectronica1TySigned)
(signature)
District Number 5660 Place Town Of Warrensburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z -7
Date of Disposition /off 2H�12 Place of Disposition
2 (address)
W
CC
(section) - (lot number)�rt (grave number)
8 Name of Sexton or Person in Charge of Premises
Zplease print)
W Signature — Title ("QL_Mp)1 a-
DOH-1555(07/18)p 1 of 2
1 Public Health Law Sec. 4145(2b) `
1
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# ' '"