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Dupree, Suann NEW YORK STATE DEPARTMENT OF HEALTH , s 23 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Suann Marie Dupree Female Date of Death Age If Veteran of U.S. Armed Forces, April 6, 2014 60 War or Dates F" Place of Death Hospital, Institution or L City, Town or Village Glens Falls Street Address 97 Broad St. Apt. 2 1:1 Manner of Death Natural Cause ❑ Accident ❑Homicide ❑ Suicide ❑ Undetermined ❑ Pending Circumstances Investigation W Medical Certifier Name Title CI Patricia Schmitt, Address Manor Drive Queensbury, NY 12804 Death Certificate Filed District Number % . r Register Ni 7e{, City, Town or Village ( �� ❑Burial Date Cemetery or Crematory April 10, 2014 Pine View Crematorium ❑Entombment Address ®Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z ❑ Removal and/or Held { and/or Address E Hold Date Point of d'1-1 Transportation Shipment Ui by Common Destination a Carrier ❑ Disinterment Date Cemetery Address ❑ Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom t. Remains are Shipped, If Other than Above 2 Address IX 11. Permission is hereby granted to dispose of the human remains descri rya) i i ed. Date Issued O �©J/ZD y Registrar of Vital Statistics GL2 / (signature) District Number 3 / Place -2�,� G'S, ,> I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ILE Date of Disposition 04/10/2014 Place of Disposition Quaker Road Queensbury,NY 12804 2 (address) LU (section) (lot number) (grave number) pe Name of Sexton or Person ' Charge o Premises rie'1 tAN cxk (please print) al_ Signature Title COCmtcirdZ (over) DOH-1555 (02/2004)