Castner, Nancy NEW YORK STATE DEPARTMENT OF HEALTH 'oil
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Nancy B. Castner Female
- Date of Death Age If Veteran of U.S. Armed Forces,
January 29,2018 75 War or Dates
t Place of Death Hospital, Institution or
City, Town or Village T/O Horicon Street Address 5 Ross Lane
Manner of Death IX'Natural Cause I I Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Shannon Evellis Dr.
Address
�_ 6223 SR 9,Chestertown,NY 12817
,,:if: Death Certificate Filed District Number Register Number
Q City, Town or Village T/O Horicon 5654 2
❑Burial Date Cemetery or Crematory
Pine View Crematory
❑Entombment Address
El Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
ZO I I Removal and/or Held
and/or Address
E Hold
N
0 Date Point of
O.
Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
s Name of Funeral Home Alexander-Baker Funeral Home 00037
KK' Address
:n1, 3809 Main Street,Warrensburg,NY 12885
n Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
3 Address
1
a;' Permission is hereby granted to dispose of the human remain described above s indicated.
= Date Issued /--3/' ) Sr Registrar of Vital Statistics ---0
(signature)
M ' /
y District Number 5654 Place T/O Horicon
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
1-. J�
Date of Disposition -1 2 ill Place of Disposition fin( � (-r� ►ct,--
2 (address)
w
cn
re (section) /i (lot number) (grave number)
Op Name of Sexton or Person in Charge of Premises l � S.- ..->-fGfi
Z � �i2�
Signature 4/(,✓r� (Obese print)
W Title l z(091-+PA
(over)
DOH-1555 (02/2004)