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Harpp, Nancy L. NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Nancy L.Harpp Female Date of Death Age If Veteran of U.S.Armed Forces, 11/05/2019 74 Years War or Dates F- Place of Death Hospital,Institution or WCity,Town or Village Horicon Town Street Address 6337 State Rt 8 Route, Horicon Town, New York 12815 p Manner of Death ®Natural Cause Accident Homicide Suicide Undetermined Pending VCircumstances Investigation Q Medical Certifier Name Title Kate Sauer-Jones PA Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Brant Lake 5654 10 Burial Date. Cemetery,Crematory or Facility Name 11/11/2019 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Z Date Place Removed 0 Removal and/or and/or Held F_ Hold Address N O d Date Point of U) Transportation p by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom F Remains are Shipped,If Other than Above Address f3: W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/08/2019 Registrar of Vital Statistics 7Cris'ta LWood(ECectronicallySigned) /signature/ District Number 5654 Place Brant Lake, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition Place of Disposition i W 2 (address) W 0 Ix (section) (lot number) (grave number/ aName of Sexton or Person in Charge of Premises Ol L ter"+l Z (pl se print) W Signature Title DO H-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 1 3 0 s i Receipt Human remains of � '� delivered on , 20 1 Pine View Cemetery z Repmw ng the fui 'ome named on burial permit Official Funeral Directors Reg.or License# ;