Gillingham, Sheila NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
B.
SHEILA B GILLINGHAM Female
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Date of Death Age If Veteran of U.S.Armed Forces,
July 20, 1992 55 War or Dates NO
:..::.... . .. ......................... _............. _.
Place of Death Hospital, Institution or
Cit �I �f Schenectady Street Address Ellis Hospital
W. Y. ............. . ......y.....
Manner of Deatii ® Natural Cause Accident Homicide ❑ Suicide UndeterminedS Pending
Circumstance Investigation
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W Medical Certifier Name Title
0 Stewart Silvers MD
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Address
896_Riverview_Rd.,Rexford New York
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Death Certificate Filed District Number Register Number
City,Town or Village City of Schenectady i 4601
Date Cemetery or Crematory
❑Burial July 23, 1992 Pine View Crematory
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Cremation
Address ...... :.
Queensbury, N.Y. 12804
Z Date Place Removed
O ❑ Removal and/or Held
F- and/or Hold ........ ............. .... ...... :-- ... ...-::::::
Address
O ..... .......... . . .... :....: : ......... . ........ .......44 ...... .........
IL Date Point of
cn ❑Transportation by Shipment
p Common Carrier
..........
Destination
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El Disinterment Date Cemetery Address
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El Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Firm Alexander—Baker Funeral Hone 00012
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Address
114 Main St., Warrensburg, N.Y. 12885
...........4......................44.4. ........... -:
#=. Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
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>ul>
Address
t
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued July 22, 1992 Registrar of Vital Statistics 1_? /�
(signature)
District Number 4601 Place Srhenect�dv
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
i
W Date of Disposition �.21?lace of Disposition �/ � /,L�4f .G�/�l�/v
2: (address)
u1
Cn (section) (lot number) (grave number)
cc
p: Name of Sexton Person in C4"harge of Prem' es .�]9�f/r'� 19 ZZV9
ZI. (please print) fY'
W Signature Title �i�iCei>rf /
DOH-1555 (10/89) p. 1 of 2 VS-61