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Husson, Alene A
) \0`)3/4. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Alene A. Husson Female Date of Death Age If Veteran of U.S.Armed Forces, 12/26/2023 74 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W Manner of Death ❑ ❑ ❑ ❑ ❑Undetermined �Pendin el X Natural Cause Accident Homicide Suicide g W Circumstances Investigation W Medical Certifier Name Title CI William Cleaver MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 613 FilBurial Date Cemetery,Crematory or Facility Name 12/29/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Z❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 d Date Point of U)DTransportation p by Common Shipment Carrier Destination oDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Miller Funeral Home 01199 Address 6357 Nys Rte#30, Indian Lake,New York 12842 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/28/2023 Registrar of Vital Statistics Megan Nolin(Electronically 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: I— W Date of Disposition /Z 30—Zc n-,,z3 Place of Disposition Ale /,et,�; C'y-e y144 t- 2 (address) W U) CC (section) (lot number) / (grave number) 0 Name of Sexton or Person in Charge o remi s )kI 3,' ✓Z A 'I. 6t Z c. (please print) W Signature �,i / Title c i.)-(744 )c- DOH-1555(07/18)p 1 of 2 r 01.7739 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#