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Sullivan, Sharon Ann LF # 15y NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Sharon Ann Sullivan Female Date of Death Age If Veteran of U.S.Armed Forces, 12/04/2023 73 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Lake George Village Street Address 22 Cooper Street 3,Lake George Village,New York 12845 `p Manner of Death ❑X Natural Cause Accident Homicide Suicide ❑Undetermined Pending Circumstances Investigation W Medical Certifier Name Title Lynn Keil PA Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Village Of Lake George District Number Register Number City,Town or Village 5620 8 Burial Date Cemetery,Crematory or Facility Name 12/06/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 8❑Removal Date Place Removed and/or and/or Held Hold Address 0 d Date Point of Transportation by Common Shipment Carrier Destination ODisinterment Date Cemetery Address OReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above "S Address CC W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/06/2023 Registrar of Vital Statistics JulieACCen(ECectronica1TySigned) (signature) District Number 5620 Place Village Of Lake George I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I- Z Date of Disposition 1111 11 Place of Disposition ri Ne-f OF- doer;..__ W 2 (address) W Q (section) 2 (lot number) (grave number) 8 Name of Sexton or Person in Charge of Premises lh L H Z % ease print/ W Signature Title `' Wiwi�iivt DOH-1555(07/18)pi 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 permit Official Funeral Directors Reg.or License#