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French, Nancy Elaine t � NEW YORKSTATE DEPARTMENT OF HEALTH • Burial - Transit Permi Bureau of Vital Records Name First Middle Last Sex Nancy Elaine French Female Date of Death Age If Veteran of U.S.Armed Forces, 03/27/2021 72 Years War or Dates H Place of Death Hospital,Institution or WCity,Town or Village Moreau Town Street Address 40 Tanglewood Drive, Moreau Town, New York 12803 p Manner of Death © Natural Cause El Accident ❑Homicide ❑Suicide ❑Undetermined El Pending W Circumstances Investigation W Medical Certifier Name Title G Thomas Coppens MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Moreau 4562 19 Burial Date Cemetery,Crematory or Facility Name 03/29/2021 Pine View Crematory Entombment Address ElCremation Queensbury Town,New York Donation Z Removal Date Place Removed and/or and/or Held F-usHold Address 0 Date Point of (I) Li Transportation Shipment Q by Common Carrier Destination Ei Disinterment Date Cemetery Address Date Cemetery Address 0 Reinterment 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 % Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/29/2021 Registrar of Vital Statistics Leeann Mc cabe(Electronically Signed) (signature) District Number 4562 Place Moreau, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition 3130111 Place of Disposition 1 gat►►_ Of,---- fW (address) W q CC (section) // (lot number) (grave number) D Name of Sexton or Person in Charge of Premi `s f' �`" ` S.—NA t (p/ease print) z ( ',I iW Signature Title DOH-1555(o7/t8)pi of 2 Public Health Law Sec. 4145(2b) - 3 14679 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#