Aitken, Susan Catherine (LF -)3c
NEW YORK STATE DEPARTMENT OF HEALTH \,' Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Susan Catherine Aitken Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/10/2022 80 Years War or Dates
~ Place of Death Hospital,Institution or
Z City,Town or Village Johnsburg Town Street Address Elderwood at North Creek
WW Manner of Death Undetermined Pending
El Natural Cause IllAccident Homicide Suicide
U Circumstances Investigation
W Medical Certifier Name Title
G Michael Miles MD
Address
112 Ski Bowl Rd,Johnsburg Town,New York 12853
Death Certificate Filed Town Of Johnsburg District Number Register Number
City,Town or Village 5655 25
Burial Date Cemetery,Crematory or Facility Name
09/19/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
- Hold Address
0
0. Date Point of
tf)EITransportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
a Address
CC
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/19/2022 Registrar of Vital Statistics jean 94 Comstock(ECectronica1Ty Signed)
(signature)
District Number 5655 Place Town Of Johnsburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IH
Z Date of Disposition °�)iq I ZZ Place of Disposition(L
ar
(a dress)
W
N
CC (section) (lot numbeFLwti1 (grave number)
SName of Sexton or Person in Charge of Premises \
(please print)
W Signature C/J ` Title W
DOH-1555(o7/18)p t of 2
i. .. 6..8., .3241
Public Health Law Sec. 4145(2b)
Receipt
Human remains of I " -' delivered on , 20
,, %;, c, ,
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# " ' e
1