Canale, Susan NEW YORK STATE DEPARTMENT OF HEALTH [-QF ,o_s
•Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Susan Canale I Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/26/2022 I
63 Years I War or Dates
Place of Death I Hospital Institution or
City,Town or Village Syracuse Street Address Bishop Rehabilitation and Nursing Center
G
Mannerof Death ONaturalCause ❑Acddent El Homicide OSukide ❑Undetermined ❑Pending
W
V Circumstances Investigation
1 Medical Certifier Name Title
Terri Levine NP
Address
918 James St,Syracuse,New York 13203
Death Certificate Filed County of C)nondaga District Number Register Number
Cit ,Town or Village 3300 3223
Burial Date Cemetery,Crematory or Facility Name
07/28/2022 Pine View Crematory
Entombment Address
Cremation Queensbury,New York
CDonation
Removal Date Place Removed
F
and/or and/or Held
aj Hold Address
0
Date Point of
U) ransportation
a by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
�Reinterment
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
}- Remains are Shipped,If Otherthan Above
31 Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/2812022 Registrar of Vital Statistics Afk' sAfignano(F,iecctmx S014
(signature)
District Number 3300 Place County of Onondaga
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 73D-Z9ZZ Place of Disposition ! r e o :c J Cre- #4 ril
W (eddtess)
N
Cr (section) ,/ Ilot nu er/ (grove number/
Name of Sexton or Person in Cha of Pr ises jq/ 210 i� et4,1
z Weise print/
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Signature a{se /ie litle tee3-04!
DOH 1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 1
Receipt
Human remains of delivered on , 20
7;r,
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#