Delaney, Sharon Lee / ci. N\,..
NEW YORK STATE DEPARTMENT OF HEALTH ' Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Female
Sharon Lee Delaney
Date of Death Age If Veteran of U.S.Armed Forces,
11/25/2022 74 Years War or Dates
1,, Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
ILI
0 Manner of Death Ei Natural Cause DAccident ❑Homicide [] []
Suicide Undetermined []Pending
' 'Circumstances I 'Investigation
G Medical Certifier Name Title
Sean Bain MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 591
Burial Date Cemetery,Crematory or Facility Name
11/28/2022 Pine View Crematory
Entombment Address
EICremation Queensbury Town,New York
ElDonation
Z❑Removal Date Place Removed
and/or and/or Held
F- Hold Address
N
0
Date Point of
N❑Transportation Shipment
Q by Common
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
dReinterment
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
F- Remains are Shipped,If Other than Above
a Address
EC
W •
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/28/2022 Registrar of Vital Statistics Megan.Noln glectranica*Signet9
(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:
~ Zit,
Place of Disposition (�
W Date of Disposition II (address)
f,vtV
ILI (grave number)
CC (section)0 r (lot number)
�,
Name of Sexton or Person in Charge Premises (p se print)
z (KAgIOC
W Signature Title
DOH-1555(o7/t8)p 1 of 2
0 :6 6
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#