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Sherman, Cody William ._ ------ ) , ,161 2--' NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Cody William Sherman Male Date of Death Age If Veteran of U.S.Armed Forces, 09/22/2021 27 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address 100 Park Street,Glens Falls,New York 12801 111 0 Manner of Death ©Natural Cause 1=1 Accident ❑Homicide I=1 Suicide ❑Undetermined ❑Pending W Circumstances Investigation LU Medical Certifier Name Title C Keith Schenker MD Address 1101 ltt Street,Schenectady,New York 12308 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 415 ElBurial Date Cemetery,Crematory or Facility Name 09/25/2021 Pine View Crematorium ❑Entombment Address X❑Cremation Queensbury Town,New York ▪Donation OZ 0 Removal Date Place Removed and/or and/or Held F— Hold Address N 0 0 Date Point of U) Li Transportation Shipment p by Common Carrier Destination Date Cemetery Address ID Disinterment Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom i— Remains are Shipped,If Other than Above S Address IX W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/24/2021 Registrar of Vital Statistics Wp6ert Andrew Curtis(E(ectronicaltySigned) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: i�Z Date of Disposition I ill 1Zl Place of Disposition l '^t�t,_ 2 (address) LU NIX (section) /) (lot number) (grave number) SName of Sexton or Person in Charge of Pre is s 2 ` i4A4tt z (qt,-- print) LU c Title ke-44'4101C DOH-1555(07/18)p 1 of 2 315 1. 7 9 Public Health Law Sec. 4145(2b) Receipt Human remains of ` ° f` delivered on } , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#