Pratt, Sherry NEW YORK STATE DEPARTMENT OF HEALTH
VitalNecords Section Burial - Transit Permit
Name First Middle Last Sex
Sherry Lynne Pratt Female
Date of Death Age If Veteran of U.S. Armed Forces,
July 28, 2012 52 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Street Address Glens Falls Hospital
Manner of Death1=1 Natural Cause 111 Accident 0 Homicide 0 Suicide riUndetermined 0 Pending
Circumstances Investigation
, Medical Certifier Name Title
"` Paul F. Bachman, ME
Address
Warrensburg, NY 12885
Death Certificate Filed District Nut rr Regis±j.Huber
City, Town or Village \ --x�
El Burial Date Cemetery or Crematory
August 4, 2012 Pine View Cemetery
- Entombment Address
0Cremation Quaker Road Queensbury,NY 12804
Y,
Date Place Removed
Removal and/or Held
7 and/or Address
• Hold
h 3' Date Point of
. ❑Transportation Shipment
by Common Destination
' Carrier
▪ ❑ Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
• Permit Issued to Registration Number
▪ Name of Funeral Home M.B. Kilmer Funeral Home 01078
p. Address
t.
:, ,= 136 Main Street, South Glens Falls NY 12803
• Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
- - Address
,
Permission is hereby ranted to dispose of the human remains des abed bo as i i ed.
Date Issued Y2 .,2i 20/2- Registrar of Vital Statistics
(signature)
District Number yj O/ Place 67Q _/ , me
• I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 08/04/2012 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
Horicon 8 D 2
`, (section) (lot number) (grave number)
- Name of Sexton or Pers i Charge of Premises Michael Genier
(please print)
" Signature .".' Title Superintendent
(over)
DOH-1555 (02/2004)