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Manley, Susan A
4 ...:::F...). # NEWYORKSTATEDEPARTMENTOFHEALTH Bu 1 Bureau of Vital Records real - Transit Permit Name First Middle Last Sex Susan A.Manley Female Date of Death Age If Veteran of U.S.Armed Forces, 02/26/2023 75 Years War or Dates f. Place of Death Hospital,Institution or Z City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare pManner of Death EI Natural Cause Accident ❑Homicide Suicide Undetermined El Pending VCircumstances Investigation QMedical Certifier Name Title Brandii Baker NP Address 4573 State Route 40,Argyle Town,New York 12809 Death Certificate Filed Town Of Argyle District Number Register Number City,Town or Village 5750 12 Burial Date Cemetery,Crematory or Facility Name 03/01/2023 Pine View Crematory Entombment _ Address ; ©Cremation Queensbury Town,New York Donation Z Date Place Removed O❑Removal and/or and/or Held P. Hold Address N 0 C= Date Point of (I) Transportation 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 M Address CC Ill 0- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/01/2023 Registrar of Vital Statistics Shofleygdckernon(ECectronicairySigned) (signature) District Number 5750 Place Town Of Argyle I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 3)2 1 Z3 Place of Disposition ,,, i 4-- M address) W U) CC (section) /lotnumber/C (grave number) • Name of Sexton or Person in Charge of Premi es _, \�iv.� Z (p ase print) W Signature Title i1(it!/1 ,7&. DOH-1555(07/18)pi of 2 _ Q 74 1..r e T Public Health Law Sec. 4145(2b) Receipt Human remains of ° delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#