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Nissinoff, Meryl irlf 4 II 1 Ii9 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Vital Records Section K Name First Middle Last Sex w Meryl S Nissinoff Female Date of Death Age If Veteran of U.S.Armed Forces, '' 06/01/2018 66 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ElUndetermined ❑Pending Circumstances Investigation w Medical Certifier Name Title 171 Jennifer Stratton MD tv Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 279 §DBurial Date Cemetery or Crematory 06/04/2018 Pine View Crematory xi El Entombment Address ®Cremation Queensbury Town, New York Ix `< Date Place Removed ❑Removal and/or Held and/or Address Hold Date Point of Q Transportation Shipment ' by Common Destination Carrier 41 Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number 3 Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address ( 53 Quaker Rd,Queensbury,New York 12804 iz x;` Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address IT a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/04/2018 Registrar of Vital Statistics Wg6ertA Curtis(ECectronica((y Signed) (signature) F District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I0 Date of Disposition t'r a Ilg Place of Disposition 1uv.,., t ji. )tor.., a (address) t» Le (section) (lot numb ) (grave number) Name of Sexton or Person in Charge of Premisesw1trL ''^'twt illi b (please print)Signature /— - Title f `r" (over) DOH-1555 (02/2004)