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Bailey, Sherry Troby It 23 NEW YORK STATE DEPARTMENT OF HEALTH ' t ' Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Sherry Troby Bailey Female Date of Death Age If Veteran of U.S.Armed Forces, 01/06/2022 67 Years War or Dates H Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death © Natural Cause ❑Accident 0 Homicide Ei Suicide 0 Undetermined El Pending UCircumstances Investigation Q Medical Certifier Name Title William Cleaver MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 14 Burial Date Cemetery,Crematory or Facility Name 01/10/2022 Pine View Crematory 0 Entombment ---- - • -- ---- — — Address — -- — — -- - - X❑Cremation Queensbury Town,New York ❑Donation ZZ• Removal Date Place Removed and/or and/or Held H Hold Address N 0 Cl)a ❑Transportation Date Point of p by Common Shipment Carrier Destination Date Cemetery Address ❑Disinterment Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom -- Remains are Shipped,If Other than Above N Address CC W EL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/07/2022 Registrar of Vital Statistics Megan Notin(ECectronicaCCy Signed) (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— W Date of Disposition i if(f Zz Place of Disposition ell-- � � 2 (address) W N C (section) (lot number) (grave number) Name of Sexton or Person in Charge of Pre •ses /ha f t— ii 4 6i z (ple se print) tL Si nature Ct A"iliP(l g Title DOH-1555(07/18)p 1 of 2 552E Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on ' ` " , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#