Hammond, Shelly Sue NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial --Transit Permit
Name First Middle Last Sex
ly Slit-
Hammond F
Date of Death Age If Veteran of U.S. Armed Forces,
Allcr 26 1995 23 War or Dates NA
Place of Death Hospital, Institution or
City, Town or Village Johnsburg Street Address Hudson St.
Manner of Death Natural Cause Accident ®Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Barbara Wolf ME
Address
Albany,NY
Death Certificate Filed District Number Register Number
City, Town or Village Johnsburg 5655
Date Cemetery or Crematory
❑Burial 9-7-95 Pine View Crematory
Address
Cremation Queensbury,NY
gDate Place Removed
Z❑Removal d/or Held
•- and/or Address
an
Hold
Date Point of
Q Transportation Shipment
by Common Destination
Carrier
[�Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Alexander FH Re017 on Number
Name of Funeral Home 00
Address
North River,NY
! Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as ind" ated.
Date Issued 9-6-95 Registrar of Vital Statisticso-X
(si ature)
District Number 5655 Place T/0 Johnsburg,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
A
W. Date of Disposition "" I Place of Disposition //L V a;� ' � �t�
w (address)
(section) (lot um er) (grave number)
QName of Sext or Person in Charge ot Premises
(please print) N
Signature Title L �
DOH-1555 (10/89) p. 1 of 2 VS-61