Sherman, Charlotte fb
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Charlotte M.Sherman Female
Date of Death Age If Veteran of U.S. Armed Forces,
09/12/2017 81 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
w Manner of Death a Natural Cause 0 Accident 0 Homicide 0 Suicide El Undetermined ri Pending
Circumstances Investigation
it Medical Certifier Name Title
Dean Reali DO
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 488
❑Burial Date Cemetery or Crematory
09/15/2017 Pine View Crematory
['Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
0 Date Point of
DI 0 Transportation Shipment
, by Common Destination
Carrier
❑Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
CC
ILI
:C Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/15/2017 Registrar of Vital Statistics Wp6ertACurtis Efectromcaaysigned
(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:
Z
LEI Date of Disposition '(((tIll Place of Disposition f L ' or__
(address)
fa
(section) //��// (lot number) (grave number)
Name of Sexton or Person in Charge of Premises It
S ....kit
z ( lease print)
- Signature s11 Title jn!04
(over)
DOH-1555 (02/2004)