Nason, Howard NEW YORK STATE DEPARTMENT OF HEALTH 4 # 133
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
NI N ' Howard A. Nason Male
Date of Death Age If Veteran of U.S. Armed Forces,
February 27, 2014 83 War or Dates Korea
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
El
Manner of Death Natural Cause Accident Homicide Suicide Undetermined El Pending
Circumstances Investigation
Medical Certifier Name Title
Ems._-
Jennifer Hayes, M.D
,` Address
35 Gilbert Street Cambridge, NY 12816
4'" Death Certificate Filed District Number \ RegisterAumber
City, Town or Village Glens Falls 1-1 1
❑Burial Date Cemetery or Crematory
February 28, 2014 Pine View Crematory
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
,< Date Place Removed
Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
'- by Common Destination
aCarrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
f�t Name of Funeral Home M. B. Kilmer Funeral Home 01077
,: Address
' 123 Main St., Argyle NY 12809
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 2-I 2 - //y Registrar of Vital Statistics LA; C-A-A. �, A,\-cA}
a,, (signature)
District Number 5 60 I Place 6 (R,nnS' Vc 5 1 NIy'
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 02/28/2014 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
i (section) It number) (grave number)
Name of Sexton or Person ' Charge of Premises .- 44141
(pl ase print)
,, Signature Title Gttg^gat
(over)
DOH-1555 (02/2004)