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Clifford, Susan Elizabeth it SI N EW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Susan Elizabeth Clifford Female Date of Death Age If Veteran of U.S.Armed Forces, 01/13/2024 81 Years War or Dates F— Place of Death Hospital,Institution or Z City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare W Manner of Death Undetermined Pendin Natural Cause Accident Ei Homicide Suicide g W Circumstances Investigation Medical Certifier Name Title Brandii Baker NP Address 4573 State Route 40,Argyle Town,New York 12809 Death Certificate Filed Town Of Argyle District Number Register Number City,Town or Village 5750 6 Burial Date Cemetery,Crematory or Facility Name NOM 01/16/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed - and/or and/or Held H- Hold Address to 0 d Date Point of Cl)❑Transportation Shipment Q by Common Carrier Destination O Disinterment Date Cemetery Address Reinterment Date Cemetery Address 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 Address CC W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/16/2024 Registrar of Vital Statistics ShelTey Mckernon(ECectronicafiySigned) (signature) District Number 5750 Place Town Of Argyle I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IF— Z Date of Disposition I 111 I71 Place of Disposition .i6v r✓;J (FPT2 — 2 (address) W CC N (section) 4 (lot number/— (grave number) Name of Sexton or Person in Charge of P mises J, Z l lease print/ W Signature Title ( Tit DOH-1555(07/18)p 1 of 2 . a 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#