Sharrow, Nathalie 14 3
NEW YORK STATE DEPARTMENT O' .,ALTH
Vital Records Section • Burial - Transit Permit
Name First Middle Last Sex
Nathalie M. Sharrow Female
Date of Death Age If Veteran of U.S.Armed Forces,
August 31,2011 74 • War or Dates
.. Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death g Natural Cause 'Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
O Paul Bachman MD
Address
H HN,Warrensburg,NY 12885
Death Certificate Filed District Number RLrmber
City, Town or Village Glens Falls,NY 5601
❑Burial Date Cemetery or Crematory
September 2,2011 Pine View Crematory
Entombment Address
Cremation Quaker Rd.,Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
Hold
r)
O Date Point of
N Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00035
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
I- Remains are Shipped, If Other than Above
Address
O.
Permission is hereby granted to dispose of the human remains descri d ab ve in i ed.
Date Issued 9-2-11 Registrar of Vital Statistics
(signature)
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition /-L-a0 t.j Place of Disposition ?t v c.u�a c. i C-r -e vrt 440 V' v Pr)
2 (address)
U)
O (secti (lot nu r) (grave number)
0 Name of Sexton or Person in Charge of emises (:vs-.c1--4.� 3(`v.n pi e
`Z (please print)
Signature 444 Title CT'.e vnra..'(ar 4 -1 .
7 (over)
DOH-1555(02/2004)