Howard, Suasan Agnes (42
),
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Susan Agnes Howard Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/10/2022 72 Years War or Dates
Place of Death Hospital,Institution or
IZ City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc
p Manner of Death El Natural Cause Accident El Homicide nSuicide FlUndetermined El Pending
W
U Circumstances Investigation
W Medical Certifier Name Title
a Carrie Miron PA
Address
319 Broadway,Fort Edward Town,New York 12828
Death Certificate Filed Town Of Fort Edward District Number Register Number
City,Town or Village 5755 73
X Burial
M Date Cemetery,Crematory or Facility Name
10/15/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
O. Date Point of
Cl)❑Transportation Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
OReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-South Glens Fats 01078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
t— Remains are Shipped,If Other than Above
1- Address
IE
W
EL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/12/2022 Registrar of Vital Statistics Aimee G Mahoney(ECectronicaliySigned)
(signature)
District Number 5755 Place Town Of Fort Edward
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
z t`y iVy /ab'oi
W Date of Disposition \0•1�- 0�107 Place of Disposition Si 0u,G,�,e,(2, � �X1�x.1
2 (address)
N U1�adi\1/2&a-• ,55A C2
Ilr (section) (lot number) (grave number)
8 Name of Sexton or Person in Charge of Premises ,n n i e. 6:oeaeJe---
zc (please print)
W Signature Title Jui n
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
012949
Receipt
Human remains of 5.t-t SN 4.1 71 'g) -( delivered on /c) /'C" , 20 7
1 ' r
View Cemetery Representing the funeral home named pn burial permit
'.fficial Funeral Directors Reg.or License#
HOWARD
NAME Ssan Agnes Howard ! )ie: 72
Lot Owner: Susan Howard
Lot# Unadilla Ext 55A Grave# 2
Case: Concrete
Died: 1 0.1 0.2 2 Interred: 1 0. 1 5.2 2
Funeral Home: M.B. Kilmer FH
Cemetery: pine View