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Sawyer, Ethel 1 * 110 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit giiii Name First Middle Last Sex Mi Ethel G. Sawyer Female NiDate of Death Age ' If Veteran of U.S. Armed Forces, 03, 201 3 84 yrs. War or Dates no Place Hospital, Institution or €g City, Town or Village Fort Edward Street Address Fort Hudson Healthcare Manner of Death © Natural Cause 0 Accident 0 Homicide ❑Suicide ❑ Undetermined 0 Pending Circumstances Investigation id Medical Certifier Name Title iP Maureen Hyland_ FNP. Address 319 Broadway, Fort Edward, NY. 12828 Death Certificate Filed District Numbe Regist r umber City, Town or Village Fort Edward j Date C�me'tery or Crematory El Burial April 03, 2013 PineView Crematorium Address L.Cremation Queensbury, NY. 12804 FDate Place Removed 0❑Removal and/or Held i•• and/or Address aHold 0 Date Point of NE Transportation Shipment a by Common Destination Carrier Li Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number ` 3 Name of Funeral Home Mason Funeral Home 0111 7 ;;, Address :::':3 18 George St. , Fort Ann, NY. 12827 iiiiii Name of Funeral Firm Making Disposition or to Whom t" Remains are Shipped, If Other than Above Address 1 X Permission is hereby granted to dispose of the human ins described ove a ndicated. iiiiiq Date Issued 4/n 3/1 3 Registrar of Vital Statisti s p ,(y (signature) gil District Numbe,15-75 Place Town of PD/Q ' tr/1?,eaNY. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: f- / 6 Date of Disposition y't ( 2 13 Place of Disposition 2di„J -441,-- 2 (address) 1L I U) CC (section) (ot number- (grave number) Name of Sexton or Person in Charge of Premises s 11 g (please print) LU Signature Title (i M co&. (over) DOH-1555 (9/98)