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Bailey, Sharon NEW YORK STATE DEPARTMENT OF H AL R. Vital Records Section Burial - Transit Permit Name First Middle Last Sex z Sharon Ann Bailey Female Date of Death Age If Veteran of U.S. Armed Forces, ,'�' March 1, 2017 72 War or Dates Place of Death Hospital, Institution or zel iCity, Town or Village Glens Falls Street Address 29 Knight Street Manner of Death Natural Cause Accident Homicide Suicide :--I Undetermined Pending Circumstances Investigation Medical Certifier Name Title PC John Stoutenberg MD, M.D. Dr. 4,41 rim Address 102 Park St. Glens Falls, NY 12801 Death Certificate Filed District Number Register Number 1 39 City, Town or Village . c.) 0 Burial Date Cemetery or Crematory March 2, 2017 Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed '2 ❑ Removal and/or Held and/or Address Hold Pine View Crematorium CA Date Point of ❑Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address 4s1; Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address x Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address ILI `1-4`1 Permission is hereby granted to dispose of the human ,emains de ribed above as indic. ed. Date Issued 0'-314,1)1 7 Registrar of Vital St- 'sties i _ ..,e.A1P (signature) District Number 5�, l Place ��,��� � A I certify that the remains of the decedent identified above we,- disposed of in accordan' with this permit on: ii: ; Date of Disposition 03/02/2017 Place of Disposition Quaker Road Queensbury,NY 12804 (address) ir (section) x (lot number) C (grave number) / Name of Sexton or Person in Charge of emises l rru �r0, Aim I0 Z (please print) tlJv., Signature Zli 67 Title iRf O - (over) DOH-1555 (02/2004)