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Devino, Susan Lynn NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Susan Lynn Devino Female Date of Death Age If Veteran of U.S.Armed Forces, 09/15/2021 58 Years War or Dates F— Place of Death Hospital,Institution or W City,Town or Village Hudson Falls Village Street Address 35 Main Street 1, Hudson Falls Village,New York 12839 p Manner of Death © Natural Cause 11 Accident El Homicide ❑Suicide ❑Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title p William Parker MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Hudson Falls Village 5726 25 ElBurial Date l Cemetery,Crematory or Facility Name 09/24/2021 I Pine View Crematorium Entombment Address ElCremation Queensbury Town,New York Donation ZO Removal Date Place Removed and/or and/or Held H Hold Address N 0 n. Date Point of Cl) Li Transportation Shipment by Common p Carrier Destination Date Cemetery Address ❑Disinterment Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67, Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom ▪ Remains are Shipped,If Other than Above Address W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/17/2021 Registrar of Vital Statistics CynthiaA Bardin(ECectronicaCCy Signed) (signature) District Number 5726 Place Hudson Falls Village, New York I certify that the remains of the decedent identified above were disposed of in accordance` / with this permit on: W ff5-.2 Date of Disposition ,7/ Place of Disposition � ,J e �/M efril (torn 4' I 2 (address) W N /section CC (lot number (grave number) ( ::t::et00 onif Premises /pleaseprint) / Title betrW DOH-1555(o7/18)p t of 2 Public Health Law Sec. 4145(2b) Receipt 1 Human remains of ; delivered pn , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#