Hanley, Nanette NEW YORK STATE DEPARTMENT OF HEALTH # 51 `Q
vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Nanette Hanley Female
Date of Death Age If Veteran of U.S.Armed Forces,
7/29/2016 63 War or Dates -
Place of Death Hospital. Institution or
City, Town or Village Glens Falls , Street Address Glens Falls Hospital
Manner of Death 0 Natural Cause ❑Accident El Homicide 0 Suicide n Undetermined n Pending
Circumstances Investigation
W Medical Certifier Name Title
G Sean Bain
Address
100 Park Street 12801
Death Certificate FiledDistrict Number RegisNer
City, Town or Village $
Burial Date Cemetery or Crematory
8/2/2016 Pine View Crematory
❑Entombment Address
ElCremation 21 Quaker Road,Queensbury New York 12804
Date ' Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
fiti 0 Transportation Shipment
O by Common Destination
Carrier
[i Disinterment ; Date Cemetery Address
El Reinterment t Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home 01079
Address
82 Broadway, Fort Edward,New York 12828
Name of Funeral Firm Making Disposition or to Whom
h. Remains are Shipped, If Other than Above
Address
CC
W.
a" Permission is hereby granted to dispose of the human remains described above as Indicated.
Date Issued 1 I l 1-6 Registrar of Vital Statistics k)C i) W
( )
District Number 5 6 01 Place 6 Ccu,.-S cv, \ S i iu. y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition f 13(/,. Place of Disposition rinrOir., � °-i^-
(addr ss)
fsaeoon) (id number Wave number)
Name of Sexton or Person in Charge of Premises 6`.4 �r 3L'""1
z (vim-w ►
... Signature Le- Title 4 )
(over)
DOH-1555(02/2004)