Sherman, Shirley . ... 19
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Shirley B. Sherman Female
Date of Death Age If Veteran of U.S. Armed Forces,
March 31,2014 76 War or Dates
. Place of Death Hospital, Institution or
z City, Town or Village Glens Falls 1 Street Address Glens Falls Hospital
W Manner of Death Undetermined Pending
p X Natural Cause Accident Homicide Suicide
W Circumstances Investigation
W Medical Certifier Name Title
p _ Paul Bachman
Address
HHHIN,Warrensburg,NY 12885
Death Certificate Filed District Number Registf Ngber
0
City, Town or Village Glens Falls 5601 ``
❑Burial Date Cemetery or Crematory
❑Entombment April 1,2014 Pine View Crematory
Address
El Cremation 21 Quaker Rd.,Queensbury,NY 12804
Date Place Removed
Z
Removal and/or Held
and/or Address
H Hold
0 1 Date I Point of
a.
Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to 1 Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped, If Other than Above
E Address
W
a
Permission is hereby granted to dispose of the human remains des ribe a ve i dicated.
Date Issued Registrar of Vital Statistics
(signature)
District Number 5601 Place Glens Falls
I certify that the remains of the� decedent identified above were disposed of in accordance with this permit on:
tit7 Date of Disposition 7 -4 Place of Disposition \/ 4%1✓ C �
(address)
W
(section) of nu ber) (grave number)
O r/ /
p Name of Sexto P rs Charge of Premises t 1 i,�'/r9e7 C'
(please print)
W �
Signature Title (��1 -0//1 114
(over)
DOH-1555 (02/2004)