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Busch-Scardino, Nancy
NEW YORK STATE DEPARTMENT OF HEALTH • ' • Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Female Nancy Busch-Scardino Date of Death Age If Veteran of U.S.Armed Forces, 05/24/2021 59 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W Mannerof Death Undetermined Pending Ip ©Natural Cause Accident Homicide Suicide V Circumstances Investigation W Medical Certifier Name Title Q Melody Long PA Address 100 Park Street,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 223 El Burial Date Cemetery,Crematory or Facility Name 05/27/2021 Pineview Crematory ElEntombment Address EjCremation Queensbury Town,New York Donation Date 1 Place Removed ZO ❑Removal and/or Held H and/or U) Hold Address 0 Point of Q. ❑Transportation Date Shipment p by Common Carrier Destination Date Cemetery Address Disinterment Date Cemetery Address ElReinterment Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom Ir Remains are Shipped,If Other than Above 2 Address LIC a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/27/2021 Registrar of Vital Statistics Robert Andrew Curtis(Electronically Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on.. lr— S 4c.---- W Date of Disposition �'11 j l( Place of Disposition (ad ssi W number) 2 (section) (lot number) (grave a I 2 In Name of Sexton or Person in Charge of Pre . s (pleas print) W Title (w a2 Signature DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 1 4 15 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#