Bingell, Sharon Lynn �_ A # z t4(J
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Sharon Lyn Bingen Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/14/2022 48 Years War or Dates
H, Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
la
p Manner of Death ENatural CauseEAcci 0Homicide Suicide ❑Undetermined ❑Pending
Circumstances Investigation
WMedical Certifier Name Title
CI Asim Chaudry MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed oily Of Glens Fats District Number Register Number
City,Town or Village 5601 166
Burial Date Cemetery,Crematory or Facility Name
03/16/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
DDonation
❑Removal Date Place Removed '
and/or and/or Held
NHold Address
0
C. Date Point of
U)❑Transportation
a by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
ElReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
- Remains are Shipped,If Other than Above
5 Address
CC
W
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/16/2022 Registrar of Vital Statistics Megan Xe ngYctranlcaQj'.SY9n4
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I— `r
Z Date of Disposition dill +Zt Place of Disposition ;K,V� , f-drt.�_
W (address)
W
to CC (section) d _(lot number) (grave number)
fil
g Name of Sexton or Person in Charge of Premises `.tr�' K
lease print)
Lu 61 f win/,
Signature --� Title
DOH i555(WAS)p i of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery `Representing the funeral home named on burial perm.*
Official Funeral Directors Reg.or License# 4`