Sherwood, Rodney 4 CO
NEW YORK STATE DEPARTMENT OF HEALT
Vital Records Section 1Burial - Transit Permit
IIli
Name First Middle y Last Sex
Rodney J. Sherwood ,/ Male
Date of Death Age If Veteran of U.S. Armed Forces,
08/10/2018 65 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Milton 1 Street Address 479 Rowland St.
Manner of Death x Natural Cause Accident 'Homicide Suicide Undetermined Pending
Circumstances Investigation
g. Medical Certifier Name Title
P tA.03-0‘ 01. Li 6 e t 11\b
ddres 1
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Death Certificate Filed ` Distri r Nurhber / i }��' Register Number q
City, Town or Village Milton '�l
•
❑Burial Date Cemetery or Crematory
08/10/2018 Pine View Crematorium
❑Entombment Address
0 Cremation Quaker Rd. Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
V) -
0 Date Point of
NTransportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
=4, Permit Issued to Registration Number
Name of Funeral Home Mason Funeral Home _ 01117
Address
P.O. Box 277, Fort Ann,NY 12827
Name of Funeral Firm Making Disposition or to Whom
M. Remains are Shipped, If Other than Above
Address
Doi Permission is hereby granted to dispose of the human : ains des 'bed above as indicated.
Date Issued '40 1 ks'a Registrar of Vital Statu i4 s ilk v"r*��k,SZ
(signature)
District Number 1 -` ' Place ----\---- (' m\ \\- -
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition g/131(g Place of Disposition ter, A-1a_I—
W (address)
CO
O (section) (lot/umber) (grave number)
pName of Sexton or Person in Charge of P emises I hs ' Si,viri
Z (please nt)
W
Signature Title alkAilitit
(over)
DOH-1555 (02/2004)