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Fuller, Susan A
tt NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Susan A.Fuller Female Date of Death Age If Veteran of U.S.Armed Forces, 04/08/2023 70 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Hadley Town Street Address 33 First Avenue,Hadley Town,New York 12836 Lp Manner of Death 0 Natural Cause ❑Accident ❑Homicide Suicide FlUndetermined 1-1 Pending V Circumstances Investigation O Medical Certifier Name Title Paul Filion MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed Town Of Hadley District Number Register Number City,Town or Village 4558 Burial Date Cemetery,Crematory or Facility Name 04/11/2023 Pineview Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed F= and/or and/or Held N Hold Address N❑Transportation Date Point of by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above a Address Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/10/2023 Registrar of Vital Statistics Colleen Demarsh(Electronically Signed) (signature) District Number 4558 Place Town Of Hadley I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F W Date of Disposition Lj Ii i[ Place of Disposition ;^', 2 (add ss) W CC (section) it (lot number) (grate number) O Name of Sexton or Person in Charge of Pre is s /" r'' � i ft Z (please print) W Signature Title Crtcni r DOH-1555(07/18)p 1 of 2 k 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#