Stone, Nancy , ,
NEW YORK STATE DEPARTMENT OF HEALTH' /
Vital Records Section Burial - Transit Permit
'a Name First Middle Last Sex
Nancy L. Stone Female
Date of Death Age If Veteran of U.S. Armed Forces,
-• February 11,2017 76 War or Dates
i xa Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death g Natural Cause Accident I I Homicide Suicide Undetermined Pending
Circumstances Investigation
jj Medical Certifier Name Title
;gip Noelle M. Stevens
Address
100 Broad St.,Glens Falls,NY 12801
Death Certificate Filed District Number Register umber
City, Town or Village Glens Falls 5601 10r
❑Burial Date Cemetery or Crematory
February 14,2017 Pine View Crematory
El Entombment Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
ZZ n Removal and/or Held
and/or Address
H Hold
Co
0 Date Point of
N Transportation Shipment
6 by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
:';. Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
'S' Address
3809 Main Street,Warrensburg,NY 12885
:i: Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
C.; Permission is hereby granted to dispose of the human emain describe above as indi ate
�_ Date Issued O=21/4 _fir,/7 Registrar of Vital Statistics �� ) / 6
r signature)
a District Number r'� Place T �� ,..6
I certify that the remains of the decedent identified above were disposed of in accordanwith this permit on:
Z
tu Date of Disposition 7l/il/'7 Place of Disposition ?The } G,J C r',nu--/i3r/
W / (address)
CO
CL (section) (lot number) (grave number)
pName of Sexton or P n 'n Charge of Premises J ire/,�-�T 6�.Nn.o..e,( e
z (please print)
W Signature 22b - Title C e ri(P e e d,pe
y
(over)
DOH-1555 (02/2004)