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Drew, Cheryl 1' s NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section _ Transit � Name First Middle Last Sex Cheryl Lynn Drew Female Date of Death Age ` If Veteran of U,S. Armed Forces, 12/26/2018 59 War or Dates Place of Death Hospital, Institution or �, City,Town or Village Granville, NY l Street Address The Orchard Nursing and Rehab Centre Ct Manner of Death Natural Cause a Accident E3 Homicide 0 Suicide 0 Undetermined 0 Pencong' Circumstances Investigation Medical Certifier Name Title • Leonard Gelman MD Address 10421 State Rte 40,Granville, NY 12832 Death Certificate Filed District Number Register..Number City,Town or Village Granville 5756 73 )Burial Date Cemetery or Crematory Oilloiz.die P,r V;e Cce1V1c4c ,„.. - ©Entombment Address ['Cremation Qaak,e.r R. A. Qu1.arS J ry 4.)`f i&Foy, Date Place Removed n Removal and/or Held 1-4 I and/or Address Hold Date Point of 0 Transportation Shipment "Ittoo by Common Destination Carrier Disinterment Date Cemetery Address 0 Reinterment Date Cemetery Address Permit Issued to Carleton Funeral Home, Inc. Registration Number Name of Funeral Home 12782 Address 68 Main Street, Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address .. 4 '. Permission is hereto granted to dispose of the human remains described above asIndicated.; Date Issued g I lb 1 Ao ly Registrar of Vital Statistics �,, t cu,,uurxe (signature) District Number 6 7 S(o Place Tow 0 t9 P C.r U 0 tt.LE I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 1 /1 0/2I01.9Place of Disposition _mPine View Cemetery QueenShnry IT (address) Horicon 42—E 1 °" (sector) (lot number) (grave number) V' Name of Sex or Person in Charge of Premises Connie L. Goedert (please pang Signature kit-t Ce-eclair Title __ Cemetery Superintendent (over) DOH-1555 (02/2004)