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Martha Sherman
9 try NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records _ __ Name First Middle Last Sex Martha Sherman Female Date of Death Age If Veteran of U.S.Armed Forces, 11/16/2023 57 Years War or Dates Place of Death I Hospital,Institution or City,Town or Village Kingsbury Town 1 Street Address 211 Deer Run Drive B,Kingsbury Town,New York 12839 5 Manner of Death ❑X Natural Cause Accident Homicide ESuicide nUndetermined ri Pending W I—I V Circumstances Investigation aILI Medical Certifier Name Title Lynn Keil PA Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Kingsbury District Number Register Number City,Town or Village 5762 17 EBurial Date Cemetery,Crematory or Facility Name 11/18/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York ODonation Removal Date Place Removed Eand/or and/or Held Hold Address (f)II Transportation Date Point of by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom E- Remains are Shipped,If Other than Above 2 Address CC ILI a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/17/2023 Registrar of Vital Statistics Cynthia Bardin(ECectronicauTy Signed) /signature) District Number 5762 Place Town Of Kingsbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition //I/Z'2'-3 Place of Disposition :Je ae,. .> (-1�y1/4 le r S ILI 2 (address) IIi Q (section) (lot number/ i (grave number) 8 Name of Sexton or Person in Charge o remis Rs//nte.4 S lL'OM Z (please print) W Signature (, pI4 Title G/t�'s4.479-J- tl DOH-1555(07/18)p i of 2 Py,72 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#