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Kaveny, Susan Ann 4 31V NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Susan Ann Kaveny Female Date of Death Age If Veteran of U.S.Armed Forces, 04/01/2020 68 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation p Manner of Death ©Natural Cause ❑Accident Homicide ❑Suicide El Undetermined ❑Pending W Circumstances Investigation WMedical Certifier Name Title 0 Jean Flanagan MD Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 155 Burial Date Cemetery,Crematory or Facility Name 04/03/2020 Pine View Crematorium Entombment Address 0 Cremation Queensbury Town,New York ❑Donation ZO ❑Removal Date Place Removed and/or and/or Held N Hold Address O Q. Date Point of N ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition orto Whom E. Remains are Shipped,If Other than Above Address Q W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/03/2020 Registrar of Vital Statistics q?9bertAndrew Curtis(ECectronicaCCy Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H Z Date of Disposition b 110 Place of Disposition ���. n,— W 2 (address) W N (section/ llotnumber/ (grave number/ Q SName of Sexton or Person in Charge o remises Z ase print/ ul Signature Title DOH-1555(07/18)p 1 of 2 i Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Fine View Cemetery Representing the funeral home named on burial permjr/ Official Funeral Directors Reg.or License# r��'