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Lundgren, Suzanne CLark s , NEWYORKSTATEDEPARTMENTOFHEALTH sr Bureau of Vital Records Burial - Transit Perm Name First Middle Last Sex 1: Suzanne Clark Lundgren Female Date of Death Age If Veteran of U.S.Armed Forces, 05/23/2023 81 Years War or Dates F- Place of Death _Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death IJ Natural Cause Accident Ei Homicide ESuicide I=IU Pending W C.) Circumstances Investigation WQ Medical Certifier Name Title Mathew Varughese DO Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 267 BurialEl Date Cemetery,Crematory or Facility Name 05/24/2023 Pine View Crematory Entombment Address ©Cremation Queensbury,New York DDonation 0❑Removal Date Place Removed — and/or and/or Held - Hold Address 0 O. Date Point of N Transportation 5 by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 2 Address DC W 0. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/24/2023 Registrar of Vital Statistics Megan.NoCin(ECectronicalry Signed) (signature) District Number 5601 Place City Of Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of DisILIposition S)/S'JZ3 Place of Disposition .�,� - /` 1 (address) W CO Cr (section/ // (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premise r//� L ft 2 please print/ W nature �� g Title Yl '�" . 7. Si DOH-1555(07/18)p 1 of 2 f . 016990 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#