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Sherman, William E .a 11 5f) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit rs Name First Middle Last Sex William L Sherman Male Date of Death Age If Veteran of U.S.Armed Forces, 06/30/2018 70 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital 9 P' Undetermined Pending Manner of Death©Natural Cause 0 Accident 0 Homicide �Suicide 0 � Circumstances Investigation Medical Certifier Name Title Jennifer Donovan DO Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 325 ['Burial Date Cemetery or Crematory 07/03/2018 Pine View Crematorium a. ❑Entombment Address ®Cremation Queensbury, New York Date Place Removed ry❑Removal and/or Held and/or Address Hold Date Point of Q Transportation Shipment by Common Destination Carrier Q Disinterment Date Cemetery Address : Q Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 o. Address 9 Pine St,Chestertown,New York 12817 t Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address tt Permission is hereby granted to dispose of the human remains described above as indicated. kis Date Issued 07/03/2018 Registrar of Vital Statistics ,6enA Curtis(&ectronical(ySigned) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 111113 Place of Disposition iiwU-, ,n (addr ) (section) p number) (grave number) Name of Sexton or Person in Charge of Premises r,,r, 441'11 piino Signature d4 4, Title P IIT (over) DOH-1555(02/2004)