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Garner, Susan NEW YORK STATE DEPARTMENT OF HEALTH 4589 Vital Records Section Burial - Transit Permit Name First Middle Last Sex • Susan Jane Gamer Female Date of Death Age If Veteran of U.S. Armed Forces, 12/07/2018 54 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause Accident Ei Homicide El Suicide n Undetermined �Pending Circumstances Investigation " Medical Certifier Name Title ( Shahid Ahmed MD Address a 100 Park St,Glens Falls,New York 12801 - Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 582 ❑Burial Date Cemetery or Crematory 12/12/2018 Pine View Crematory ❑Entombment Address ®Cremation Queensbury Town, New York Date Place Removed ❑Removal and/or Held and/or Address Hold Date Point of Q Transportation Shipment by Common Destination ._.; Carrier Disinterment Date Cemetery Address a El Date Cemetery Address Reinterment Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address • 11 Lafayette St,Queensbury,New York 12804 te Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above ry Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/12/2018 Registrar of Vital Statistics Wp6ertA Curtis(E(ectronicalty Signed) (signature) District Number Place 5601 Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition ? -t r "18 Place of Disposition Pht, U'(1,, (e� G.3 66y (address) (section) (lot number) (grave number) - Name of Sexton or Person in Charge of Premises r.t (please print) Signature Title (over) DOH-1555 (02/2004)