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Holmes, Nancy qv NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Nanc E.Holmes Female Date of Death Age If Veteran of U.S. Armed Forces, 12/26/2017 79 Years War or Dates Place of Death Hospital, Institution or City,Town or Village Glens Falls Street Address Glens Falls Hospital ' Manner of Death Undetermined Pending �,� ©Natural Cause �Accident �Homicide �Suicide � � Circumstances Investigation ,a Medical Certifier Name Title '' Wendy Steinhacker PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number 1 City,Town or Village Glens Falls 5601 673 Date Cemetery or Crematory ^,� ❑Burial 12/29/2017 Pine View Crematory • ❑Entombment Address 04 ®Cremation Queensbury, New York .11 Date Place Removed 'ri Removal and/or Held and/or Address Hold e Date Point of Q Transportation Shipment • by Common Destination Carrier 1❑Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number . Name of Funeral Home Regan Denny Stafford Funeral Home 01443 rst Address 04 53 Quaker Rd,Queensbury,New York 12804 ttit Name of Funeral Firm Making Disposition or to Whom • Remains are Shipped, If Other than Above • Address - L• Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/28/2017 Registrar of Vital Statistics 4p6ertACurtis Ek.ctronicalCysigned (signature) ` 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: • Date of Disposition /7/Z%/7 Place of Disposition P- � ;e ) C t yn4-h ry 1 / (address) (section) (lottnnymber) (grave number) NIT '-, Name of Sexton or P rso Charge of Premises ,Jim I(-a✓` (get%' (please print) Signature Title t ��"�� (over) DOH-1555 (02/2004)