Hughes, Sherlyn NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Sherlyn Eunice Hughes Female
Date of Death Age If Veteran of U.S. Armed Forces,
11/14/2017 73 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death 0 Natural Cause Accident El Homicide Suicide ❑Undetermined 0 Pending
Circumstances Investigation
Medical Certifier Name Title
Jean Vanauken PA
XF
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
r City, Town or Village Glens Falls 5601 585
❑Burial Date Cemetery or Crematory
11/15/2017 Pine View Crematory
av❑Entombment Address
®Cremation Queensbury Town, New York
" Date Place Removed
Removal and/or Held
and/or Address
Hold
0 Date Point of
0 Transportation Shipment
by Common Destination
f Carrier _
u
Q Disinterment Date Cemetery Address
._.
Renterment 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
ili Name of Funeral Firm Making Disposition or to Whom
k Remains are Shipped, If Other than Above
16 Address
„,,,y, Permission is hereby granted to dispose of the human remains described above as indicated.
ogDate Issued 11/15/2017 Registrar of Vital Statistics &6ert Curtis �EfeamracaaySigned
(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 /Ob i n Place of Disposition d...•J V•"v,^'��
P�
(address)
(section) 4(lot number) (grave number)
it Name of Sexton or Person in Charge of Premises f .Sam►-
(plebse print)
Ai
Signature" Title MgAt11,4--
(over)
DOH-1555 (02/2004)