Lewin, Susan 1 It
NEW YORK STATE DEPARTMENT OF HEALTH � Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Susan Lewin Female
Date of Death Age If Veteran of U.S. Armed Forces,
07 / 20 / 2017 52 i War or Dates N/A
:I- P• lace of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address 55 Tamarack Trail
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0 Manner of Death❑Natural Cause 0 Accident ®Homicide Ei Suicide "'Circumstances Undetermined �Pending
W. Investigation
ta Medical Certifier Name Title
O. Daniel J. Kuhn Coroner
Address
40 McMaster St. , Ballston Spa. , NY 12020
>' Death Certificate Filed District Number Register_N�mbQ'�'
City,Town or Village Saratoga Springs Sa r �/
Burial Date Cemetery or Crematory )
07 / 25 / 2017 i Pine View Crematoiv
0 Entombment Address
'„ ': Cremation Queensbury, Ny
Date Place Removed
❑Removal and/or Held
and/or Address
0. Hold
Date Point of
❑Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
0 Renterment Date Cemetery Address
iio Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
><3 402 Maple Ave. , Saratoga Sp., NY 12866
<< Name of Funeral Firm Making Disposition or to Whom
R• emains are Shipped, If Other than Above
Address
CC
in
` P• ermission is her by gr nted to dispose of the human remain descr e bo icated.
igi
;s Date Issued -5 ) Registrar of Vital Statistics
(signature)
ni
District Number LI 5-DI
Place Saratoga Springs , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Iii Date of Disposition 7`2!p//�7 Place of Disposition ) the u f e!.✓ G Ceie t--4, Ai
/ (address)
III
LC (section) (lot number) (grave number)
0 Name of Sexton Person in Charge of Premises 11-4-rn ��1,.en ee e
z (please print)
Signature Title fee-nag-0,-
(over)
DOH-1555 (02/2004)