Webb, Susan Jane 1 DPh14.j 35v
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Susan Jane Webb Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/25/2020 71 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Queensbury Town Street Address 1 a Manor Drive,Queensbury Town,New York 12804
p Manner of Death ❑X Natural Cause El Accident ❑Homicide El Suicide El Undetermined El Pending
(Wj Circumstances Investigation
GMedical Certifier Name Title
Robert Reeves MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 230
❑Burial Date Cemetery,Crematory or Facility Name
12/28/2020 Pine View Crematory
Entombment Address
aCremation Queensbury Town,New York
ElDonation
ZO El Removal Date Place Removed
and/or and/or Held
H Hold Address
RA
°O
Ei. Date Point of
U) ❑Transportation
a by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F- Remains are Shipped,If Other than Above
2 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/28/2020 Registrar of Vital Statistics Carotinexlogard Barier(Electrortilay.SOrma9
(signature)
District Number 5657 Place Queensbury, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 12_Z9 Zd Id Place of Disposition �h Q v C �j
2 (address)
/
W
N
CC (section) (lot number) (grave number)
0 Name of Sexton or PLi
''Charge of Premises L-it ('l-v
(please print)
W Signature Title �Q
DOH-1555(07/18) of 2
) 1 A 3111
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
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