Williams, Sueann ', it log—
NEW YORK STATE DEPARTMENT OF HEALTH if , !Vital Records Section Burial - Transit Permit
:fi,x Name First Middle Last Sex
Sueann M. Williams Female
:x Date of Death Age If Veteran of U.S. Armed Forces,
,' September 28,2014 46 War or Dates
Place of Death Hospital, Institution or
2 City, Town or Village Glens Falls Street Address Glens Falls Hospital
a Manner of Death Undetermined Pending
X Natural Cause Accident Homicide Suicide
j Circumstances Investigation
1,14 Medical Certifier Name Title
°On Robert W. Sponzo
Address
=m'102 Park St.,Glens Falls,NY 12801
Death Certificate Filed District Number Registeer
City, Town or Village Glens Falls 5601
❑Burial Date Cemetery or Crematory
El Entombment September 30,2014 Pine View Crematory
Address
❑x Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
N
0 Date Point of
O.
cn Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
A Permit Issued to Registration Number
=F' Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
4 Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
la
* Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued G ( Z-y 11 ,'0C 4 Registrar of Vital Statistics lA .,W�ti� ht(signat e)
District Number 5601 Place Glens Falls) Ai y
I certify that the remains of the decedent identified above were disposed
of in accordance with this permit on:
Z DispositionI N Disposition '(' 1v^, C'r r‘...
ill Date of I��! I Place of
W (address)
co
C' (section) (lot number) (grave number)
QName of Sexton or Person in Charge of Premises Cr,st St„to-
Z' (please print)
LLJ
Signature t1rp„, Title Cier41 60n __
(over)
DOH-1555 (02/2004)