Sureting, Joseph Anthony NEW YORK STATE DEPARTMENT OF HEALTH � LF Transit Permit
Bureau of Vital Records `� Burial -
I..
Name First Addle ti east ` Sex
Joseph Anthony Surething Male
Date of Death Age If Veteran of U.S.Armed Forces,
09/11/2023 77 Years War or Dates 1967-1991
F— Place of Death Hospital,Institution or
WCity,Town or Village Granville Town Street Address 10414 New York State Route 40,Granville Town,New York 12832
tp Manner of Death ❑X Natural Cause Accident ❑Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
a Jean Harris-Letts MD
Address
278 Vermont Route 149,Pawlet,Vermont 05775
Death Certificate Filed Town Of Granville District Number Register Number
,Town orVillage Cie 5756 53
Burial Date Cemetery,Crematory or Facility Name
09/13/2023 Pine View Crematory
Entombment Address
®Cremation Queensbury Town,New York
▪Donation
ZO❑Removal Date Place Removed
- and/or and/or Held
~- Hold Address
N
0
a Date Point of
U) Transportation Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
i— Remains are Shipped,If Other than Above
2 Address
Q
UJ O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/13/2023 Registrar of Vital Statistics Jenny Linda M Marte((e(E(ectronical(ySigned)
(signature)
District Number 5756 Place Town Of Granville
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 4---...._
Date of Disposition qji517 3 Place of Disposition �~i,
W (address)
UJ
N CC (section) A(iot number) (grave number)
8 Name of Sexton or Person in Charge of Pre ` n' �
z (pi print /
W Signature `/ Title `�'�
DOH-1555(07/18)p 1 of 2
w ►
'1 7f'l0r
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# ,