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Culter, Jacqueline Marie-Paule 111(......15 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Jacqueline Marie-Paule Cutler Female Date of Death Age If Veteran of U.S.Armed Forces, 05/08/2023 93 Years War or Dates i_ Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address 110 Sagamore Street 2H, Glens Falls, New York 12801 p Manner of Death El Natural Cause Accident 0 Homicide Suicide Undetermined Pending (W) Circumstances Investigation WQ Medical Certifier Name Title Lynn Keil PA Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 245 Burial Date Cemetery,Crematory or Facility Name 05/10/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury,New York Donation 0❑Removal Date Place Removed p and/or and/or Held Si N Hold Address 2 Date Point of (/)OTransportation a by Common Shipment Carrier Destination oDisinterment Date Cemetery Address OReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan&Denny Funeral Service 01444 Address 94 Saratoga Ave,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom F— Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/10/2023 Registrar of Vital Statistics Megan Wolin(ECectronicatTySigned) (signature) District Number 5601 Place City Of 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 51j( 11.3 Place of Disposition �i,,,,� Z4 _ 't 2 (address) ?,1 W N Q (section) I (lot number) \ (grave number) SName of Sexton or Person in Charge of Premises ,a ri Zp/ease print/ / IU Signature Title rrnW(lYL DOH-1555(07/18)p 1 of 2 6958 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#