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LaRocque, Suzanne E
*4 #/4‘,,t) NEW YORKSTATE DEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Suzanne E.LaRocque Female Date of Death Age If Veteran of U.S.Armed Forces, 06/01/2023 97 Years War or Dates i_ Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation p Manner of Death Natural Cause ❑Accident 0 Homicide ESuicide Undetermined Pending ILI C.) Circumstances Investigation LIU G Medical Certifier Name Title Courtney Diamond NP Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 278 Burial Date Cemetery,Crematory or Facility Name '., 06/05/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York DDonation 0❑Removal Date Place Removed and/or and/or Held I Hold Address U) 0 O. Date Point of Cl) Transportation Q by Common Shipment Carrier Destination oDisinterment Date Cemetery Address OReinterment 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 I— Remains are Shipped,If Other than Above S Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/05/2023 Registrar of Vital Statistics Megan WoCin(ECectronicaCCy 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: /, Z Date of Disposition b)Z Place of Disposition �f�---.._ W 2 (address) W U) CC (section) 11 (lot number) C (grave number) gName of Sexton or Person in Charge of Premises �'�^i Z / 1(please print) W cem Signature l Title ` h ( DOH-1555 l07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 1 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#