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Guilder, Susan Jessie
ci........._D--. � � �NEW YORKSTATE DEPARTMENT OF HEALTHBurial - Transit Permit Bureau of Vital Records �» Name First Middle Last Sex Susan Jessie Guilder Female Date of Death Age If Veteran of U.S.Armed Forces, 11/01/2023 69 Years War or Dates H Place of Death Hospital,Institution or WCity,Town or Village Albany Street Address St Peters Hospital p n Manner of Death Natural Cause IllAccident n Homicide 7Suicide EllUndetermined Pending `U I I Circumstances Investigation W Medical Certifier Name Title CI Ashley Bird PA Address 315 S Manning Blvd,Albany,New York 12208 DeaRth Certificate Filed City Of Albany District Number Register Number City,Town or Village 0101 2596 Burial Date Cemetery,Crematory or Facility Name 11/03/2023 Pine View Crematory Entombment Address - - ©Cremation Queensbury Town,New York ▪Donation Z❑Removal Date Place Removed and/or and/or Held H Hold Address () 0 d Date Point of (A OTransportation p by Common Shipment Carrier Destination Date Cemetery Address nDisinterment Date Cemetery Address E Reinterment Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above g Address IE W LL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/02/2023 Registrar of Vital Statistics Kerry Warttitothmew(Electronicaf Signer) (signature) District Number 0101 Place City Of Albany I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— z Date of Disposition i I)t,1-0 Place of Disposition rI NFvinF,,..) CP'ic(14 f0.-,�. 2 (address) W Cl)CC (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of�P mises Z 4 !'s �I M wi� Z (plcl se print) ne6 ii TUd lL Signature Title DOH-1555(o7/18)p l of 2 .,. r t) .,., f 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#