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Sawyer, Shirley NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First _ Middle Last ' Sex ?;f:" Shirley Estella Sawyer Female Date of Death Age If Veteran of U.S. Armed Forces, 10/26/2017 81 Years War or Dates ` Place of Death Hospital, Institution or ZCity, Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc W Manner of Death©Natural Cause Accident 0 Homicide 0 Suicide 0 Undetermined Pending Circumstances Investigation its Medical Certifier Name Title CI Eileen Spinelli NP Address 319 Broadway,Fort Edward Town,New York 12828 Death Certificate Filed District Number Register Number e City, Town or Village Fort Edward 5755 49 ❑Burial Date Cemetery or Crematory 10/30/2017 Pine View Crematorium Entombment Address ®Cremation` Queensbury Town, New York Date Place Removed Z❑Removal and/or Held et and/or Address Hold CO 0 Date Point of cu El 14 Transportation Shipment 1 by Common Destination Carrier V Li Disinterment Date Cemetery Address Q Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Stpo Box 67,Hudson Falls,New York 12839 j, Name of Funeral Firm Making Disposition or to Whom 1.4 Remains are Shipped, If Other than Above 2 Address tt >iL Permission is hereby granted to dispose of the human remains described above as indicated. ,,,, Date Issued 10/30/2017 Registrar of Vital Statistics Aimee 9ktakoney ECectronicaaySigned (signature) District Number 5755 Place Fort Edward, New York F=r I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: III Date of Disposition Ii /t J r?Place of Disposition f? 0,� `' � 3 (address) to (section) (lot number) (grave number) d Name of Sexton or Person in Charge of Premises ton* ' S gg Z (p4ae print) Signature /is 4 _ Title 02e. 41'4 (over) DOH-1555 (02/2004)