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Nason, Carol Linda 4. jos ti NEW YORKSTATE DEPARTMENT OF HEALTH - Burial - Transit Permit Bureau of Vital Records Name First Middl • Last Sex Carol Linda Nason Female Date of Death Age If Veteran o .Armed forces, 12/07/2021 77 Years War or Dat ▪ Place of Death spital,Institution or W City,Town or Village Fort Edward Town Street Address: l or Hudson Nursing Center Inc p Manner of Death © Natural Cause Accident 0 Homicide 0 Suicide ❑Undetermined Pending W Circumstances Investigation W• Medical Certifier Name Title E Carrie Miron PA Address 319 Broadway, Fort Edward Town,New York 12828 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 69 ElBurial Date Cemetery,Crematory or Facility Name 12/09/2021 Pine View Crematory Entombment Address lCremation Queensbury Town,New York ❑Donation Date Place Removed O ❑Removal and/or Held F. and/or Hold Address 0 a Date Point of t/1 ❑Transportation 5by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077 Address 123 Main St,Argyle,New York 12809 Name of Funeral Firm Making Disposition or to Whom — Remains are Shipped,If Other than Above 2 Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/08/2021 Registrar of Vital Statistics Aimee G Mahoney(ECectronica1Ty Signed) (signature) District Number 5755 Place Fort Edward, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z V �. W Date of Disposition IZ Will Place of Disposition q c /�,� 2 (address) W CC N (section) (lot number) (grave number) GName of Sexton or Person in Charg remises Z (ple se print) (� UJ Signature Title ���4* 2 DOH-1555(07/18)p 1 of 2 re 5 4 2 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#