Jenkins, Sharon NEW YORK STATE DEPARTMENT OF HEALTH / jw
Vital Records Section • •-R Burial - Transit Permit
Name First Middle Last Sex
Sharon Lillian Lorraine Jenkins Female Wrf
Date of Death Age If Veteran of U.S. Armed Forces,
June 30, 2015 56 War or Dates
Place eath f(L ^ Hospital, Institution or
' Cit own r Village T r Street Address 618 Lower Wright
WManner of Death a Natural Cause 0 Accident El Homicide 0 Suicide ❑ Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
Mark Hoffman, M.D. Dr.
Address
CR Wood Cancer Center Glens Falls, NY 12801
Death Certificate Filed District_N i be Ren umber
'T�
City, Town or Village 3
❑Burial Date Cemetery or Crematory
July 1, 2015 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ri Removal and/or Held
o and/or Address
E. Hold
CO Date Point of
a. ❑Transportation Shipment
by Common Destination
CI 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
I— Remains are Shipped, If Other than Above
2 Address
W'
Permission is h e y granted to dispose of the human ains described abov as indicated.
Date Issued 7 / Registrar of Vital Statisti �. �
````� (signature
District Numbec5-23 Place /jr) �1~" / 4 -
I certify that the remains of the decedent identified above,(,ere disposed of in accordance with this permit on:
Uj Date of Disposition 07/01/2015 Place of Disposition Quaker Road Queensbury,NY 12804
2 (address)
W
Cl)
(section) i (lot number) (grave number)
0 Name of Sexton or Person in Ch ge of Premises j0'' o ky (�Fti rul/-2
W' �^ / �� (please print)
W Signature 1�"'-"T y Title Cfe n,q't err tut-
(over)
DOH-1555 (02/2004)