Deihl, Sharon NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
s Name First Middle Last Sex
.v Sharon Ruth Deihl Female
Date of Death Age If Veteran of U.S. Armed Forces,
September 9,2014 65 War or Dates
i":1:' Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death
1 X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Darci Gaiotti-Grubbs Dr.
;:; Address
;r:;r 102 Park St,Glens Falls,NY 12801
;rr;:; Death Certificate Filed District Number Register Nymber
; City, Town or Village Glens Falls 5601 L97
❑Burial Date Cemetery or Crematory
CI Entombment September 11, 2014 Pine View Crematorium
Address
EI Cremation 21 Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
N
0 Date Point of
O.
• Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
.f.� Permit Issued to Registration Number
::r Name of Funeral Home Regan Denny Stafford Funeral Home 01443
`: Address
,r~ 53 Quaker Road, Queensbury,NY 12804
;::::: Name of Funeral Firm Making Disposition or to Whom
1' Remains are Shipped, If Other than Above
Address
.;ti.; Permission is hereby granted to dispose of the human remains described abovelas indicated.
Date Issued `=j`I( 1/LI Registrar of Vital Statistics W
.. (signet e)
District Number 5601 Place Glens Falls.: A/`i
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition (nick Place of Disposition 'gal'-' 641,--
2 (address)
W
CO
O (section) // (lot numbed (grave number)
QName of Sexton or Person in Charge of Premises fhr,cte LJon/44
Z ( ease print)
W
Signature C Title E.W►R2
v (over)
DOH-1555(02/2004)