Sherman, Frances Adams NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Frances Adams Sherman Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/14/2020 85 Years War or Dates
II.- Place of Death Hospital,Institution or
WCity,Town or Village Tupper Lake Town Street Address Mercy Living Center
p Manner of Death r�—fl Natural Cause Accident Homicide El Suicide Undetermined Pending
W Circumstances Investigation
U
W Medical Certifier Name Title
Mario Tagliagambe MD
Address
114 Wawbeek Ave,Tupper Lake Town,New York 12986
Death Certificate Filed District Number Register Number
City,Town or Village Tupper Lake 1650 15
Burial Date Cemetery,Crematory or Facility Name
05/19/2020 Pine View Crematory
❑Entombment Address
5KCremation Queensbury Town,New York
Donation
Z Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
O
IL Date Point of
to ElTransportation Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
Address
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/18/2020 Registrar of Vital Statistics Laurie.7Fu&r(ElectronicallySigned�
(signature)
District Number 1650 Place Tupper Lake, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H _f
W Date of Disposition b Zfl Z� Place of Disposition —Flu 6V C-"'
(address)
W
N (section) (lot number) (grave number)
a Name of Sexton or Person in Charge of Premises °�
L
/plea a print/
Z
W Signature Title
DO H-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 13 8 M''
Receipt
I
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#