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Sharrow, Keisha NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Mii Name First Middle Last Sex Keisha Marie Sharrow Female Date of Death Age If Veteran of U.S. Armed Forces, 04 / 29 / 2017 32 War or Dates N/A } Place of Death Hospital, Institution or W City, Town or Village Glens Falls Street Address Glens Falls Hospital g Manner of Death❑Natural Cause Li Accident El Homicide El Suicide 7 Undetermined i9F Pending tij Circumstances Investigation la Medical Certifier Name Title 0 Paul F. Bachman MD Address 3767 Main St, Warrensburg, NY 12885 Death Certificate Filed District Numbg��� Register-{�lylrpber ali City, Town or Village Glens Falls �� of �/(Q ':": guiBUflal Date Cemetery or Crematory 05 / 08 / 2017 Friends Cemetery a 0 Entombment Address Cremation Queensbury, NY Date Place Removed ❑Removal and/or Held w. and/or Address Hold Date Point of Q Transportation Shipment fi by Common Destination Carrier ❑Disinterment Date Cemetery Address El Reinterment Date Cemetery Address Permit Issued to Registration Number iiiiiiii Name of Funeral Home Compassionate Funeral Care 00364 €s[ Address €'l 402 Maple Ave., Saratoga Sp. , NY 12866 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above 2 Address ir t Permission is hereby granted to dispose of the human remains describe above s in ' ed. «' Date Issued Q /O.?/ /7 Registrar of Vital Statistics • (signature) Wi ! District Number Sao/ Place Glens Falls , New York Fg # I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Dispositions )0 1-7 Place of Disposition 4ri2r\e c C-Q►'Y1.4-''r i) 6u-Q.JLn..o btW4 t to/ (addr ss) l CC (section) (lot n mber) (grave number) g Name of a ton or Pers . Charge of Premises C©0..0 f - l c ( se print) ° tt Signatur k^- Titl (over) DOH-1555 (02/2004)