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Williams, Sheila t . 1 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex f Sheila A. Williams Female Date of Death Age If Veteran of U.S. Armed Forces, " September 28, 2016 79 War or Dates n/a 4' Place of Death Hospital, Institution or City, Town or Village Glens Falls 1Street Address The Pines Of Glens Falls I�I Manner of Death Natural Cause n Accident ❑Homicide n Suicide n Undetermined n Pending Circumstances Investigation Medical Certifier Name Title . _ Melissa Decker MD v:f.0 Address r r 9 Carey Road,Queensbury,NY 12804 •f:f r ;�1: Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 507 El Burial Date Cemetery or Crematory September 30, 2016 Pine View Crematorium ❑Entombment Address ©Cremation 51 Quaker Road, Queensbury, NY 12804 Date Place Removed OZ n Removal and/or Held and/or Address F- Hold U) — O Date Point of Nn Transportation Shipment a by Common Destination Carrier El Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address �:;%/ Permit Issued to Registration Number Name of Funeral Home Regan DennyStafford Funeral Home 01443 { 3 Address 53 Quaker Road, Queensbury,NY 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address 1}f Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued (3- i 301 16 Registrar of Vital Statistics LA-) :4' (signature) r ]i4 District Number 5601 Place Glens Falls N ail I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition 1406Place of Disposition t wrap.; W (addr ss) U) O (section) // (lot number) (grave number) pName of Sexton or Person in Charge of Premises `I ` ti4/Vi Z lease print W SignatureA ,h, . _ Title 63041119/L (over) DOH-1555(02/2004)