Hall, Sherman NEW YOIRK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Sherman E. Hall Male
Date of Death Age If Veteran of U.S. Armed Forces,
March 13, 2011 88 War or Dates
Place of Death Hospital, Institution or
:Z City, Town or Village Glens Falls ; Street Address 33 Henry Street
pManner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
°W Circumstances Investigation
W Medical Certifier Name Title
°Q William Tedesco,MD
Address
Glens Falls,NY
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls,NY 5601 IC9(
0 Burial I Date 1 Cemetery or Crematory
March 16, 2011 ; Pine View Cemetery
❑Entombment Address
❑Cremation Quaker Road
Date Place Removed
Z Removal and/or Held
and/or Address
E' Hold
N
O Date Point of
O.
Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date I Cemetery Address
Permit Issued to 1 Registration Number
Name of Funeral Home Regan & Denny Funeral Home 01464
Address
53 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
I Remains are Shipped, If Other than Above
2 Address
Cd
Q. Permission is hereby granted to dispose of the human remains descr'bgd boy s in d.
Date Issued 0/OPI Registrar of Vital Statistics
(signature)
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition 5/19/11 Place of Disposition Pine View Cemetery
2 (address)
cn w S . I . #2 156 1
CL (section) (lot number) (grave number)
Q Name of Sexton or Person in Charge of Premises Michael Genier
'Z _
;f � (please print)
Signature► . Title Superintendent
(over)
DOH-1555(02/2004)