Nash, Ashley NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
777 Name First Middle Last Sex
Ashley R Nash Female
<> Date of Death Age If Veteran of U.S. Armed Forces,
5/13/97 3 War or Dates No
Place of Death Hospital, Institution or
Z City, Town or Village Glens FAlls Street Address Glens FAlls Hospital
W
Manner of DeathL. Natural Cause ®Accident ❑Homicide 0 Suicide 0 Undetermined Pending
Circumstances Investigation
liQui Medical Certifier Name Title
P Backman• Coronor
Aii Address
Warrensburg,NY
Ni Death Certificate Filed District Number Registe Number
iMi City, Town or Village Glens FAlls 5601 ,
Date Cemetery or Crematory
IA Burial 5/17/97 Pine View Cemetery
Address
❑Cremation •
Date Place Removed
0❑Removal and/or Held
and/or Address
0 Hold
O Date Point of
NQ Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
>i Name of Funeral Home Sullivan - Minahan & Potter 01877
]! Address
407 Bay Rd Queensbury,NY 12804
,, Name of Funeral Firm Making Disposition or to Whom
< " Remains are Shipped, If Other than Above
Address
AI
11
L .
Permission is hereby granted to dispose of the human remains described above as indicated.
igii Date Issued 5/16/97 Registrar of Vital Statistics Rob. ,�}- 4 Cc, -,../ L,J L.-%
(signature)
District Number 5601 Place Glens-Falls NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F-
6 Date of Disposition 5/1 7/9 7 Place of Disposition pine View Cemetery ,Qucencbur_y,NY
(address)
cn W Huron 12-A 3
CC (section) (lot number) (grave number)
0 Name of Se r Person in Charge of Premises Rodney G. Mosher
Z (please print)
Signature Title Superi ntendent
DOH-1555 (10/89) p. 1 of 2 VS-61