Wood, Suzanne NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
` Name First Middle Last Sex
Suzanne L. Wood Female
Date of Death Age If Veteran of U.S. Armed Forces,
September 12,2015 65 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address Westmount Health Care Facility
Manner of Death X Natural Cause Accident n Homicide Suicide I. Undetermined Pending
litCircumstances Investigation
Medical Certifier Name Title
Roslyn Socolof MD
Address
100 Broad St.,Glens Falls,NY 12801
{ Death Certificate Filed District Number Rig�err Number
City, Town or Village 5657 9
❑Burial Date Cemetery or Crematory
❑Entombment September 15, 2015 Pine View Crematory
Address
❑x Cremation Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
F_ Hold
0 Date Point of
et m i 'Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
•
' Permit Issued to Registration Number
=ta Name of Funeral Home Alexander-Baker Funeral Home 00035
Address
3809 Main Street,Warrensburg, NY 12885
�, Name of Funeral Firm Making Disposition or to Whom
trz Remains are Shipped, If Other than Above
. Address
a: Permission is hereby granted to dispose of the human re ins described a ove as indicated.
Date Issued9 I)S/ o?c Registrar of Vital Statistics g . -,---
(signature)
District Number 5657 Place Queensbury,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition Ilillic Place of Disposition 'FL t r pf,wti.,
W (address)
N
p0 (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises /%,.44.. S s►',44.
Z (please print)
W
Signature Title 7/ (Q
(over)
DOH-1555 (02/2004)