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Whitman, Susan A NEW YORK STATE DEPARTMENT OF HEALTH - it 331 Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Susan A.Whitman Female Date of Death Age If Veteran of U.S.Armed Forces, 10/05/2021 77 Years War or Dates 1. Place of Death Hospital,Institution or LU Z City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ©Natural Cause 1=1Accident Homicide 0 Suicide Undetermined Pending W U Circumstances Investigation G Medical Certifier Name Title Christopher Smith MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 435 ❑Burial Date Cemetery,Crematory or Facility Name 10/06/2021 Pine View Crematory ❑Entombment Address EUCremation Queensbury Town,New York ElDonation 0 Removal Date Place Removed H and/or and/or Held N Hold Address 0 D. Date Point of U) El Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Miller Funeral Home 01199 Address 6357 Nys Rte#30, Indian Lake,New York 12842 Name of Funeral Firm Making Disposition or to Whom F— Remains are Shipped,If Other than Above a Address EC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/05/2021 Registrar of Vital Statistics Robert Andrew Curtis(Electronically Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I- Z Date of Disposition fp 11 IN Place of Disposition *, LjjL_ 7,.1E01 W (address) W co (section) i (lot number) (grave number) LC 0 Name of Sexton or Person in Charge of remises PS�p /` Si t c.� /' /,!%/� (Please print) Ill Signaturez At 7- Title tr ` ii DOH-1555(0)18)p i of 2 Public Health Law Sec. 4145(2b) 015206 i 1 Receipt 1 Human remains of - '`�i delivered on • ' , 20 Pine View Cemetery Representing the funeral home named ott burial hermit Official Funeral Directors Reg.or License# - ,r, i ,.:a