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Myott, Nancy Stewart NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle ,- Last Sex Nancy Stewart Myott Female Date of Death Age If Veteran of U.S.Armed Forces, 01/12/2021 85 Years War or Dates i.., Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address 390 Church Street,Saratoga Springs, New York 12866 ILI `p Manner of Death © Natural Cause ❑Accident u Homicide ElSuicide ❑Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title O Madison Zuis NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 34 ElBurial Date Cemetery,Crematory or Facility Name 01/14/2021 Pine View Crematory EEntombment Address X❑Cremation Queensbury Town,New York ElDonation Z ❑Removal Date Place Removed and/or and/or Held H Hold Address CD 0.. Date Point of co ❑Transportation Shipment p by Common Carrier Destination ❑Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above 2 Address CC W C' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/14/2021 Registrar of Vital Statistics John Taut Eranck(ECectronica1TySigned) (signature) District Number 4501 Place Saratoga Springs, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IF � Z Date of Disposition 1 /IS /Z1 Place of Disposition `l 'M U�•. .jt W (address) w CC (section) '/(lot number) (grave number) G Name of Sexton or Person in Charge of Premisel NILS��Nn4(fi ( (plea print) W Title Signature2 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the,funeral home named on burial permit Official Funeral Directors Reg.or License#