Nazareno, Violeta Nito to
NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middl Last Sex
Violeta Nito Nazareno Female
Date of Death Age If Veteran of U.S.Armed Forces/
06/01/2021 80 Years War or Dates
H. Place of Death Hospital,Institution or
W City,Town or Village Albany Street Address Albany Medical Center Hospital
• Manner of Death El Natural Cause ❑Accident ❑ Homicide 0 Suicide ❑Undetermined Pending
W U Circumstances Investigation
W Medical Certifier Name Title
Caleb Watkins
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 1432
Burial Date Cemetery,Crematory or Facility Name
06/03/2021 Pine View Crematory
❑Entombment Address
lCremation Queensbury Town,New York
❑Donation
• Removal Date Place Removed
and/or and/or Held
W Hold Address
0
1-1 Date Point of
Cl) ❑Transportation Shipment
p by Common
Carrier Destination
Date Cemetery Address
ElDisinterment
Reinterment 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
1— Remains are Shipped,If Other than Above
g Address
CC
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/02/2021 Registrar of Vital Statistics Dania&S y'illerpieglectronica�Signerl9
(signature)
District Number 0101 Place Albany, 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 4'U 6 I 1 Place of Disposition
IIJ
2 (address)
W
CC
Cn (section) (loteumber) (grave number)
Name of Sexton or Person in Charge of P mises r
Z (Plea print) p�
W Signature Title C ve
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 01,48 30
Receipt
1
1
Human remains of - ° (' delivered on t - -/ , 20
Pine View Cemetery Representing the funeral home named on burialpermit
Official Funeral Directors Reg.or License# „./