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Sherman, Curtis N. ,, it iiti NEW YORK STATE DEPARTMENT OF HEALTH * - 1 \\\ Vital Records Section Burial - Transit Permit Name First Middle Last Sex Curtis Leroy Sherman Male Date of Death Age If Veteran of U.S. Armed Forces, 01/19/2012 99 years War or Dates Place of Death Hospital, Institution or City,Xitna0XXXDIge Saratoga Springs Street Address Saratoga Hospital 0 Manner of Death a Natural Cause 0 Accident 0 Homicide 0 Suicide Undetermined Pending IliCircumstances Investigation tu Medical Certifier Name Title Joshua Zamer M D Address 211 Church Street, Saratoga Springs, N Y 12866 Death Certificate Filed District Number Register Number City, Zit IX X)QJUXge Saratoga Springs 4501 28 DM['Burial Date Cemetery or Crematory 01/20/2012 Park View Crematory ni(]Entombment Address ; :Cremation Schenectady, N Y Date Place Removed KEl Removal and/or Held 74*1' and/or Address F_ Hold Ca 0 Date Point of CL Q Transportation Shipment Et by Common Destination Carrier • Q Disinterment Date Cemetery Address Q Reinterment Date Cemetery Address iiN Permit Issued to Registration Number Name of Funeral Home Maynard D. Baker Funeral Home 01130 Address 11 Lafayette Street, ©ueensbury, N Y Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address CC l ` Permission is hereby granted to dispose of the human remainers ib j abo`v�as indicated. Date Issued 01/20/2012 Registrar of Vital Statistics Q c i (signature) District Number 4501 Place Saratoga Springs I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z til Date of Disposition f/Z3/g, Place of Disposition -R,�U{,a Cat; ,, (address) COtil CC (section) 1 (lot nuTb er) (grave number) 3 Name of Sexton or Person jn Charge of Pr mises4-:�1cf?�1. Jtry.t('� ", ALL. 1 (please print) SignatureTitle (2z'm1Aiort- (over) DOH-1555 (02/2004)