McNamara, Susan NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last I Sex
Susan E. McNamara Female
Date of Death Age If Veteran of U.S. Armed Forces,
• April 27,2011 56 War or Dates
2• Place of Death Hospital, Institution or
; City, Town or Village Glens Falls I Street Address Glens Falls Hospital
cil Manner of Death U Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Pi Dr John Stoutenberg,MD
Address
Glens Falls,NY
Death Certificate Filed 1 District Number Re 'st tuber
City, Town or Village Glens Falls,NY 5601
❑Burial Date Cemetery or Crematory
April 28, 2011 1 Pine View Crematory
❑Entombment Address
12 Cremation Queensbury, NY
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
N
O Date Point of
NTransportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Sullivan Minahan & Potter 01675
Address
407 Bay Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
lN+ Remains are Shipped, If Other than Above
g Address
us
W.
▪ Permission is hereby granted to dispose of the human remains describ dab ve in d.
Date Issued OY/7`20// Registrar of Vital Statistics `.
(signature)
• District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
UJ L .l Date of Disposition ' ti Place of Disposition -?,�U,� Lt' :fio'iun—
(address)
W
U)
re (section) (lot numr) (grave number)
pName of Sexton or Person in Charg of Premises a 6,1 r Jr►.,,.fft"
Z 774 (please print)
W
Signature Title al eh vAtipA.—
(over)
DOH-1555(02/2004)