Sewall, Cheri , ,
NEW YORK STATE DEPARTMENT OF HEALTH # Z3
Vital Records Section Burial _ Transit Permit
Name First Middle Last Sex
Cheri Sewall Female
gii Date of Death Age If Veteran of U.S. Armed Forces,
03 / 24 / 2016 86 War or Dates N/A
}- Place of Death Hospital, Institution or Saratoga Center for Rehab &
Z City, Town or Village Ballston Spa. Street Address Skilled Nursing Care
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p Manner of Death n Natural Cause Accident Homicide E Suicide Undetermined �Pending
W Circumstances Investigation
Medical Certifier Name Title
oi 0r Zvs€ Nr 6 r�s do c.� -
''2C? cv S K.I, e22 Tuo,„ /2/ z iU
Death Certificate Filed District Number V Register Number
City, Town or Village Ballston Spa.
Burial Date Cemetery or Crematory
03 / 28 / 2016
>ii QEntombment Pine View Crematory
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Address Cremation 2/ t" 'uc� /Cn
6e . Queensbury, NY / Z80C1
Date Place Removed
Z Removal and/or Held
❑and/or Address
Hold
3 Date Point of
Q Transportation Shipment
E by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care, Inc 00364
Address
511 402 Maple Ave., Saratoga Springs, NY 12866
'' Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
it
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Permission is he eby ranted to dispose of the human rem n escri e ove as indicated.
Date Issued 3 v--e/ Registrar of Vital Statistics
(signature)
District Number q a Place Ballston Spa. , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W. Date of Disposition 3174iy(, Place of Disposition
Zit),c.i ri-kfictivirew,
(address)
14
a (section) (lot number) (grave number)
aName of Sexton or Person in Charge f Premises -, tis L Se.inlkf-
Z (please print) -
Signature Title atttilitk
(over)
DOH-1555 (02/2004)