Sanford, Susan 4 3Y6
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
vz Name First Middle Last Sex
Susan Ann Sanford Female
Date of Death Age If Veteran of U.S. Armed Forces,
04/26/2018 68 Years War or Dates
Place of Death Hospital, Institution or
` City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death p Natural Cause Accident ❑Homicide Suicide ❑Undetermined ❑Pending
Circumstances Investigation
r ' Medical Certifier Name Title
Jean Vanauken PA
4
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 210
❑Burial Date Cemetery or Crematory
04/27/2018 Pine View Crematory
* ['Entombment Address
�hr
®Cremation Queensbury, New York
Date Place Removed
❑Removal and/or Held
and/or
Address
Hold
Date Point of
Q Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Q Reinterment
Date Cemetery Address
Permit Issued to Registration Number
44.
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
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
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/27/2018 Registrar of Vital Statistics tip6ertA Curtis(�ECectronicaffySigned)
(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:
rr Date of Disposition 5 11 /j fj Place of Disposition P.,��•
(address)
1 (section) (L(Iot
number) (grave number)
Name of Sexton or Person in Charge of Pr mises 34,4it�� (pl se print)
Ili
Signature 4 Title 10-CAIA -
(over)
DOH-1555(02/2004)