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Sherman, Loretta Mae
. 1(:„.„.1-1) NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Loretta Mae Sherman Female Date of Death Age If Veteran of U.S.Armed Forces, 01/22/2024 85 Years War or Dates I— Place of Death Hospital,Institution or Z City,Town or Village Kingsbury Town Street Address 3422 Burgoyne Avenue,Kingsbury Town, New York 12839 w Manner of Death Undetermined Pending Natural Cause EAccident Homicide Suicide W Circumstances Investigation W Medical Certifier Name Title CI Autumn Webb PA Address 102 Park Street,Glens Falls, New York 12801 Death Certificate Filed Town Of Kingsbury District Number Register Number City,Town or Village 5762 4 Burial Date Cemetery,Crematory or Facility Name 01/23/2024 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 a Date Point of U)❑Transportation Shipment p by Common Carrier Destination Date Cemetery Address Disinterment 0 Reinterment Date Cemetery Address 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 H Remains are Shipped,If Other than Above Address CC O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/22/2024 Registrar of Vital Statistics Cynthia ABardin(ECectronica1CySigned) (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: If— Z Date of Disposition I 2�IZ� Place of Disposition FikEv�,k, CeieriYi D�Ti,_ W (address) W CCCC (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge o remisesZ '0 i(please print) ti W Signature Title inkTa , DOH-1555(07/18)p 1 of 2 ._ e 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#