Hardick, Nancy Jean ( z...FN.\ if _e 0 )
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
4
Name First Middle Last Sex
Nancy Jean Hardick Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/20/2022 81 Years War or Dates
i_ Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation
p Manner of Death II Natural Cause Accident Homicide Suicide Undetermined ❑Pending
W Circumstances Investigation
W Medical Certifier Name Title
CI Courtney Diamond NP
Address
170 Warren St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 535
Burial Date ' Cemetery,Crematory or Facility Name
10/22/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
0Donation
ZO❑Removal Date Place Removed
- and/or and/or Held
H- Hold Address
N
0
Date Point of
(A• Transportation Shipment
p by Common
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
0 Reinterment
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079
Address
82 Broadway,Fort Edward, New York 12828
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
Address
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W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/21/2022 Registrar of Vital Statistics Megan Nolin(Electronically Signed)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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Date of Disposition ICI1� 7Z Place of Disposition
W (address)
2
W / number) S," (grave number)
(/)CC (section)
O Name of Sexton or Person in Charge of Premises t
O ie (pleaserint)
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Signature
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