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Rose, Nanette C NEWYORKSTATEDEPARTMENTOFHEALTH �— Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Nanette C Rose Female Date of Death Age If Veteran of U.S.Armed Forces, 08/26/2021 72 Years War or Dates �.. Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address 57 Peck Street,Glens Falls,New York 12801 pManner of Death ©Natural Cause Accident Ei Homicide El Suicide Undetermined 0 Pending U Circumstances Investigation Q Medical Certifier Name Title Mark Doyle MD Address 377 Church Street,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 367 Burial Date Cemetery,Crematory or Facility Name 08/30/2021 Pineview Crematory El Entombment Address ElCremation Queensbury Town,New York EiDonation QRemoval Date Place Removed and/or and/or Held p Hold Address N 0 d. Date Point of U) j Transportation p by Common Shipment Carrier Destination ElDisinterment Date Cemetery Address ElReinterment Date Cemetery Address 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 F— Remains are Shipped,If Other than Above 2 Address EC W 0" Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/30/2021 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: Z Date of Disposition 813)I Zl Place of Disposition rk UJ if 4—, address) W (sedan) 7i(lot number) (grave number) O Name of Sexton or Person in Charge of P mises ' L t'�� (pleae print) �},,v W Signature 6 Title �M�'b't DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt 1 1 Human remains of -'� ' delivered on , 20 1 Pine View CemeteryfY Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# 1