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Fuss, Aileen NEW YORK STATE DEPARTMENT OF HEALTH g� Buria:mu l Transit Permit Vital Records Section Name First Middle Last Sex Aileen Violet Fuss Female Date of Death Age If Veteran of U.S. Armed Forces, August 16, 2016 91 War or Dates Plac- • "D zath Hospital, Institution or Ldri City, ow or Village Moreau Street Address Home of the Good Shepherd Cl Manner of Death Natural Cause ❑ Accident ❑ Homicide D Suicide ❑ Undetermined ri❑ Pending W Circumstances Investigation W Medical Certifier Name Title CI Glen Anderson RPA-C, Address Moreau Family Health South Glens Falls, NY 12803 Death e�ti icate Filed Distritt,t tber Regls)er Number City, Town o Village my ir e a L fT ((pp �((� ❑Burial Date Cemetery or Crematory August 17, 2016 Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z ❑ Removal and/or Held and/or Address 1 Hold fh Date Point of e ❑Transportation Shipment (I) by Common Destination CI Carrier Date Cemetery Address El Disinterment Date • Cemetery Address III Reinterment Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped, If Other than Above M; Address CC W 0. Permission is hereby granted to dispose of the human remai descri d a ve as indicated. Date Issued 0$!/7 WO Registrar of Vital Statistics &IV / nature)District Number p?— Place � /oQ/C�.S /ee� nu tau,u7 ,1c & ' —' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 08/17/2016 Place of Disposition Quaker Road Queensbury,NY 12804 2 (address) W CO Ce (section) (lot numpser) (grave number) pName of Sexton or Person in Charge of Premises (utrL,- t.. z (please print) W Signature o �' Title aliCIATK (over) DOH-1555 (02/2004)