Hamlin, Suzan NEW YORK STATE DEPARTMENT OF HEALTH G(/�
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Suzan Lee Hamlin Female
Date of Death Age If Veteran of U.S. Armed Forces,
January 7, 2016 81 War or Dates
}., Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address The Warren Center
0 Manner of Death I[I Natural Cause Accident ( 1 Homicide n Suicide n Undetermined Pending
ttlf Circumstances Investigation
in Medical Certifier Name Title
0 Roslyn Socolof Dr.
Address
42 Gurney Lane,Queensbury,NY 12804
Death Certificate Filed District Number Rtgi ter Number
City, Town or Village Queensbury 5657
❑Burial Date Cemetery or Crematory
January 9, 2016 Pine View Crematory
III Entombment Address
0 Cremation Quaker Road, Glens Falls,NY 12804
Date Place Removed
z C Removal and/or Held
and/or Address
H Hold
N
p Date Point of
N ❑Transportation Shipment
p by Common Destination
Carrier
Li Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
`1
Permission is hereby granted to dispose of the human r m ins described a e as indicated.
Date Issued ' t I I 0 kpRegistrar of Vital Statistics V u�
(signature)
District Number 5657 Place Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z CrYM4 it* .i
� Date of Disposition f/liilb Place of Disposition �fln4üj,c,i
(address)
W
tt (section) n (lot numbep' (grave number)
pName of Sexton or Person in Charge f Premises 6''ir) J!boat
Z please print)
Luf ,/ Title Signature ]�
(over)
DOH-1555(02/2004)