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Ludlow, Susan Bonnie NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Per It Bureau of Vital Records Name First Middle Last Sex Susan Bonnie Ludlow Female Date of Death Age If Veteran of U.S.Armed Forces, 08/24/2023 82 Years War or Dates H Place of Death Hospital,Institution or W City,Town or Village North River Hamlet Street Address 11 Whispering Pines Way,North River Hamlet,New York 12856 p Manner of Death ❑X Natural Cause Accident El Homicide ESuicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title Curtis Gedney MD Address 454 Glen Street,Glens Falls,New York 12801 Death Certificate Filed Town Of Johnsburg District Number Register Number City,Town or Village 5655 31 Burial Date Cemetery,Crematory or Facility Name 08/26/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0 Removal Date Place Removed and/or and/or Held i- Hold Address to 0 14. Date Point of f/) Transportation Shipment p by Common Carrier Destination ElDisinterment Date Cemetery Address EIReinterment 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 2 Address CC a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/25/2023 Registrar of Vital Statistics Jean M 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: WDate of Disposition Z 6 ZGZ3 Place of Disposition ) ,Ale_ ,/ a t) '(re 4h 2 (address) W N (section) (lot number? (grave number) of/iY7 C"�J Name of Sexton or Person in Charge�f remiss �}'!"/l1/d 1� I / (please print) W Signatures `/ Title (Q�' f✓1J_ DOH-1555(07/18)p 1 of 2 �/ • M f ''rY ' r Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 f` Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#