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Sutiliff, Betty J
it -)c,uo NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Betty J.Sutliff Female Date of Death Age If Veteran of U.S.Armed.Forces, 09/13/2023 83 Years War or Dates F Place of Death Hospital,Institution or WCity,Town or Village Johnsburg Town Street Address Elderwood at North Creek p Manner of Death IllNatural Cause Accident 0 Homicide Suicide nUndetermined ❑Pending W 0 ' 'Circumstances Investigation W Medical Certifier Name Title CI Leah Terry NP Address 4573 State Route 40,Argyle Town,New York 12809 Death Certificate Filed Town Of Johnsburg District Number Register Number City,Town or Village 5655 35 ElBurial Date Cemetery,Crematory or Facility Name 09/15/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held F Hold Address N 0 IL Date Point of N Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address Reinterment Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500,Lake Luzerne,New York 12846 Name of Funeral Firm Making Disposition or to Whom F Remains are Shipped,If Other than Above 2 Address Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/15/2023 Registrar of Vital Statistics Jean M Comstock(Electronically 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: H 4_........,Z Date of Disposition (1s (� Place of Disposition W (address) W NCC (section) do /!ot number/ /grave number/ Name of Sexton or Person in Charge of Pr ises �-` ti 0 ase print) W Title t ""'�" Signature DOH-1555(07/18)p 1 of 2 31 7 ')C.. 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#