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Lohret, Shelia Roberta , .F fag NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Sheila Roberta Lohret Female Date of Death Age If Veteran of U.S.Armed Forces, 12/21/2023 90 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc 111 p Manner of Death El Natural Cause Accident Homicide Suicide nUndetermined ❑Pending IliC.) Circumstances Investigation MI 0 Medical Certifier Name Title Carrie Miron PA Address 319 Broadway,Fort Edward Town, New York 12828 Death Certificate Filed Town Of Fort Edward District Number Register Number City,Town or Village 5755 110 Burial Date Cemetery,Crematory or Facility Name 12/21/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town, New York Donation 0❑Removal Date Place Removed and/or and/or Held F— Hold Address N 0 Cl- Date Point of N❑Transportation CI by Common Shipment Carrier Destination ElDisinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077 Address 123 Main St,Argyle,New York 12809 Name of Funeral Firm Making Disposition or to Whom F.. Remains are Shipped,If Other than Above 2 Address CC W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/21/2023 Registrar of Vital Statistics Aimee G Mahoney(ECectronica1Ty Signed) (signature) District Number 5755 Place Town Of Fort Edward I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— W Z Date of Disposition / Z2-lob 3 Place of Disposition � tXe.) Cor- a e ' fedy r 2 /address/) W CC (section) y� / (lot number) (grave number) 0 Name of Sexton or Person in Charge of Pr ises 1� !�!/1'1��� /,r/�� Z / (please print/ W Signature l ? tam/0'd�' Title 0ear:-V DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) m 77 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#