Nash, Brandy NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name Fist MT-Chile Last Sex
• Brandy
------ -L=- —Nash Female
Date of Death Age If Veteran of U.S. Armed Forces,
5/13/97 _ 25 War or Dates No
.14 Place of Death Hospital, Institution or
City, Town or VillageGlens FAlls Street Address Glens Falls Hospital
Manner of Death! Natural Cause ]Accident n Homicide n Suicide n Undetermined n Pending
Circumstances Investigation
w Medical Certifier Name Title
0 P_Badgnan--= Coronor
Address
Warrensburg,NY
Death Certificate Filed District Number Register umber
City, Town or Village Glens FAllls 5601 7
• ;;----77 I Date Cemetery or Crematory
L J Burial 5/17/97 Pine View Cemetery
Address
❑Cremation
_ -- Queensbury,NY_--
Date Place Removed
0 n Removal _ and/or Held
..- and/or Address
F' Hold
4 Date Point of
tttri n Transportation Shipment
a by Common Destination
Carrier
l l Disinterment ate Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Sullivan - Minahan & PottPr 01877
Address — - - _
iiii: 407 Bay Rd Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
11' Remains are Shipped, If Other than Above
c Address
al
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 6/16/97 Registrar of Vital Statistics 17.062,,,3`'/.4 C,cc.,x,�y f (,.,i;,v)
(signature)
District Number 5601 Place Glens FAllls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
1.
WDate of Disposition 5/17/97 Place of DispositionPine View Cemetery ,Queensbury,NY
(address)
Cl) Huron 12-A 2
Er (section) (lot number) (grave number)
0 Name of Sextoi etson in Cliarge of Premises Rodney G. Mosher
z (please print)
1 Signature Title Superintendwnt-
DOH-1555 (10/89) p. 1 of 2 VS-6-1