Cook, Susan NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
iiig Susan f. Cook Female
Date of Death Age I If Veteran of U.S. Armed Forces,
December 29, 1998 51 War or Dates
Place of Death Hospital, Institution or
• City, Town or Village Glens Falls Street Address Glens Falls Hospital
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A Manner of Death Natural Cause Accident ❑Homicide ❑Suicide ri❑ Undetermined ❑Pending
ttl Circumstances Investigation
tu Medical Certifier Name Title
4 John Layden MD
Address
90 South Street, Glens Falls, N.Y. 12801
iiiiiiiii
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5 6 U / 6 LI Z
Date Cemetery or Crematory
❑Burial January 4, 1999 Pineview crematory
Address
®Cremation Queensbury, N.Y.
Date Place Removed
0❑Removal and/or Held
N and/or Address
Hold
O Date Point of
N ❑Transportation Shipment
by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
'» Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Funeral Service 01565
Address
53 Quaker Rd. , Queensbury, New York 12804
'' �� Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
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s Permission is hereby granted to dispose of the human remains described above as in to
<: Date Issued tZj 3 i 193- Registrar of Vita! Statistics
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(signature)
iiiiii District Number 56 D/ Place 61_0,,,,,5 \\S/N k 12 0 1
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
lF- i /f��i. -�
ill Date of Disposition f Place of Disposition /Y� �,' ) L�/jl,�/�/9/�j 'J J/�
(address)
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CC (section) (lot umber) (grave number)
O Name of Sexton or Person in Charge of Premises -P4 /�,f� /Vf177P '�
g (please print)4 rr
441 Signature Title ��I,&/W9k-i- y /3--; r
(over)
DOH-1555 (9/98)