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Lynes, Nancy NEW YORK STATE DEPARTMENT OF HEALTH it Vital Records Section Burial - Transit Permit Name First Middle Last Sex ' Nancy A. Lynes Female Date of Death Age If Veteran of U.S. Armed Forces, December 26, 2010 84 War or Dates Place of Death Hospital, Institution or t¢-< City, Town or Village Glens Falls Street Address Glens Falls Hospital .t Manner of Death 0 Natural Cause El Accident n Homicide El Suicide L jr—iUndetermined El❑ Pending Circumstances Investigation Medical Certifier Name Title Farhana Kama! MD, Address , Glens Falls Hospital Glens Falls, NY 12801 Death Certificate Filed District Number Register Numb r City, Town or Village 5 6 6 Date -. 0 Burial Cemetery or Crematory December 29, 2010 ❑Entombment Address ©Cremation Date Place Removed . Removal and/or Held and/or Address ' Hold Pine View Crematorium Date Point of Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address Reintermentit Date Cemetery Address t. Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00276 . Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above ,, Address *fit Permission is hereby granted to dispose of the human remains described above as indicated. 1 Date Issued i 2./ ?.3/i c Registrar of Vital Statistics )C3 kiti (signature) District Number 560 j Place 6 ^-v..S Vcd �s , N Y °, I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 12/29/2010 Place of Disposition .NJ;,ui CtGtOrIto-- (address) - . . (section) (Licti4t1( (lot number) (grave number) Name of Sexton or P ron in Chargemises S)a hdt (please print) Signature Title «t-fiw i U{. (over) DOH-1555 (02/2004)