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Hammond, Sharron NEW YORK STATE DEPARTMENT OF HEALTH k -DI°L Vital Records Section Burial - Transit Permit Name First Middle Last Sex Sharron Ann Hammond Female Date of Death Age If Veteran of U.S. Armed Forces, June 15, 2011 74 War or Dates Place of Death Hospital, Institution or City, Town or Village re,'n y5 bv; Street Address Manner of Death El Natural Cause Accident El Homicide Suicide Undetermined r7 Pending Circumstances Investigation Medical Certifier Name Title Jennifer Stratton, MD Address 14 Manor Drive Queensbury, NY 12804 Death Certificate Filed District Number Regist�jr Number City, Town or Village S 7 b a 1. ❑Burial Date Cemetery or Crematory 06///7/0/.0/ Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Removal Date Place Removed ri and/ and/or Held Hold Address Date Point of ElTransportation Shipment by Common Destination Carrier ElDisinterment Date Cemetery Address Renterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00276 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 Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued b-/7-1 if Registrar of Vital Statistics C.3'Q jj (signature) District Number 7 b a Place to \qL`V oS be r 7 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition i,/Lo I ti Place of Disposition f L itw 61^1-c fdrw� (address) (section) (lot numb (grave number) Name of Sexton or Per n in Charge of remises Ity oritt (please print) Signature Gc� Q Title Ll �n�T 9— (over) DOH-1555(02/2004)