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Parrott, L Shelia Tr NEW YORK STATE DEPARTMENT OF HEALTH NEW Vital Records Section Burial - Transit Permit r . Name First Middle Last Sex L Shelia Parrott Female Date of Death Age If Veteran of U.S.Armed Forces, F May 2, 2011 61 War or Dates Z Place of Death Hospital, Institution or W City,Town,or Village Whitehall Street Address G Manner of Death ❑Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑ Pending W Circumstances Investigation O Medical Certifier Name Title W Max Crossman MD 0 Address 65 Poultney Street Whitehall New York 12887 Death Certificate Filed District Number Register Number City,Town or Village Whitehall 76 ❑Burial Date Cemetery or Crematory May 6, 2011 Pineview Crematorium ❑Entombment Address a 0 Cremation Queensbury, NY 12804 Date Place Removed 4 ❑Removal and/or Held and/or Address I" Hold 0 Date Point of 0 ❑Transportation Shipment O. by Common Destination Carrier Date Cemetery Address 8 ❑Disinterment ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Jillson Funeral Home, Inc. 00897 Address 46 Williams Street, Whitehall, New York 12887 H Name of Funeral Firm Making Disposition or to Whom X Remains are Shipped, If Other than Above W Address 0. Permission is hereby granted to dispose of the human remains descri ed above as indicated. Date Issued f�;�-X©// Registrar of Vital Statistics „ signature)(s ) District Number :.'"/3:k Place Whitehall,New York F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition 05/06/2011 Place of Disposition Pineview Crematorium 2 (address) III N 0 0 (section) (lot number) (grave number) O Name of Sexton or Pers n in Charge of Premises A r.s Ki'r Se rki{l- 2 (phase print) Signature (7 k - Title CO0%v}idfk.- (over) DOH-1555 (02/2004)