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Durrum, Nancy tr NEW YORK STATE DEPARTMENT OF HEALTH , t I g Vital Records Section Burial - Transit Permit Name First Middle Last Sex Nancy Elizabeth Durrum Female Date of Death Age If Veteran of U.S. Armed Forces, December 7, 2017 82 War or Dates Place of Death Hospital, Institution or City, Town or Village Argyle Street Address 11 Elm Street Manner of Death X❑Natural Cause ❑ Accident ❑ Homicide ❑ Suicide D Undetermined ❑ Pending Circumstances Investigation M" Medical Certifier Name Title 0 John P. Stoutenberg, M.D. Dr. Address 102 Park Street Glens Falls, NY 12801 Death Certificate Filed District Number SAS, RegisterAuumber City, Town or Village Argyle a ‹iio ❑Burial Date Cemetery or Crematory December 12, 2017 Pine View Crematory - El Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z ❑ Removal and/or Held and/or Address Hold IA Date Point of A. ❑Transportation Shipment by Common Destination Carrier Date Cemetery Address El Disinterment ❑ Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M. B. Kilmer Funeral Home-Argyle 01077 Address 123 Main St., Argyle NY 12809 Name of Funeral Firm Making Disposition or to Whom 3 Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human re " s described above as indicated. Date Issued l D)t a / i 1 Registrar of Vital Statistics i Nin-sk,`t (signature) District Number 150 Place Aelkilt i klj I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 12/12/2017 Place of Disposition Quaker Road Queensbury,NY 12804 (address) (section) (lot number)// c (grave number) 0 Name of Sexton or Person in Charge of Pre ises C4rL4 1.-- _J u+iAC' Z. (phase print) Ili Signature - Title (c�''i<hl►1&I, (over) DOH-1555 (02/2004)