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Sherman, Hazel Mary i Alm NEW YORK STATE DEPARTMENT OF HEALTH 1....@. Bureau of Vital Records Burial - Transit Permit Name First Middle Hazel Mary Sherman Last l Sex Date of Death Age11 Female If Veteran of U.S.Armed Forces, 08/03/2022 95 Years War or Dates E. Place of Death Hospital,Institution or Z City,Town or Village JohnsburgTown W Street Address Elderwood at North Creek Q Manner of Death �NaturalCause ❑Undetermined Pending X Accident Homicide Suicide U Circumstances W Medical Certifier Name Investigation Michael Miles CI MD Address 112 Ski Bowl Rd,Johnsburg Town,New York 12853 Death Certificate Filed Town Of Johnsburg I District Number City,Town or Village 5655 Register Number 22 Burial Date Cemetery,Crematory or Facility Name -' 08/05/2022 Pineview Crematorium Entombment Address Cremation Queensbury Town,New York Donation r 0Z❑Removal Date Place Removed E and/or and/or Held N Hold Address 0 a. Date Point of N❑Transportation (p by Common Shipment Carrier Destination Disinterment Date Cemetery Address 1 Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Radloff Funeral Home Inc 01425 Address 136 Wan-en St,Glens Falls,New York 12801 Name of Funeral Firm Making Disposition or to Whom j.- Remains are Shipped,If Other than Above sAddress Ir W Q' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/05/2022 Registrar of Vital Statistics Jean M Comstock(Electronically Signed) (signature) District Number 5655 Place Town Of Johnsburg I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:rr Date of Disposition 3-6-Zp1L / i Place of Disposition tit iJ:ei.c.) Cre-A4a40 1 LS - (address) W 2 (section) (lot umber)(( (grave number) 8 Name of Sexton or Person in Charge o remises A Y‘ 1©_A 00,-1 z 7777ptease print) e � ItJ Signature Titlr���� DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 1 Receipt 1 , , Human remains of delivered on , ta- i / / Pine View Cemetery Representing the funeral homOnamed on burial permit Official Funeral Directors Reg.or License# ' "" t