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Storlie, Sherrie NEW YORK STATE DEPARTMENT OF HEALTH it /7 Vital Records Section ' • Burial - Transit Permit Name First Middl Last Sex Sherrie Sue lie Female Date of Death Age I eteran of U. rmed Forces, January 2016 67 @r or Dat I— Place of Dea Hospital, I i ution or WCity, Town o Villag= Hudson Falls Street Address 87 John Street WManner of Dea Fa Natural Cause ❑ Accident E Homicide Ej Suicide ❑ Undetermined El 1--1 Pending C.) CircumstancesInvestigation W Medical Certifier Name 'Title David Foote Md, Address Rt 4 Hudson Falls, 839 Death C . ate Filed istrict Number Register Number a�f`City, wn ill .i t s 1 r y 57 a G. ❑Burial Date // emeterCrematory February 2, 2016 Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed Removal and/or Held and/or Address Hold CO Date Point of Transportation Shipment CO by Common Destination a Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped, If Other than Above MAddress W tl. Permission is here y granted to dispose of the human remai described above as indicated. Date Issued a E,L /6 Registrar of Vital Statistics ` (signature) • District Number Er) Place �Jl ,, Ra_c.)__ I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: • Date of Disposition 02/02/2016 Place of Disposition Quaker Road Queensbury,NY 12804 2 (address) W 0) Q (section) (lot number (grave number) p; Name of Sexton or Person in Charge of emises 7ti r L�1KG (please print) W Signature (�- J/�! ! a9 9 � Title � rtjrd, (over) DOH-1555 (02/2004)