Taylor-Klingler, Nancy , . .......\., 41- (.,4),
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NEW YORK STATE DEPARTMENT OF HEALTH �'
Burial - Transit Permi
Bureau of Vital Records .. --,
Name First Middle Last Sex
Nancy Taylor-Klingler Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/29/2022 70 Years War or Dates
Place of Death Hospital,Institution or
City,Town or Village Queensbury Town Street Address 824 West Mountain Road,Queensbury Town,New York 12804
Manner of Death ❑X Natural Cause Accident ❑Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
John Stoutenburg MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 185
Burial Date Cemetery,Crematory or Facility Name
12/01/2022 Pine View Crematory
Entombment
— Address
EiCremation Queensbury Town,New York
Donation
Date Place Removed
fl❑Removal
and/or and/or Held
CA Hold Address
Q
O. Date Point of
aTransportation
ZS by Common Shipment
Carrier Destination
Date Cemetery Address
a Disinterment
11 Reinterment Date Cemetery Address
`- Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
- A• ddress
53 Quaker Rd,Queensbury,New York 12804
• N• ame of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
°: s
• Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/30/2022 Registrar of Vital Statistics Caroline gfiCdegarde Barber(ECectronica((y Signed)
(signature)
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:2
++ /
Date of Disposition g-3•-2G, Z? Place of Disposition ,JQ 0;6.3 6 e---in 41e c
X (address)
Yl
1 (section) L/ (lot number) (grave number)
Name of Sexton or Person in Charge of P mise �1lr t�� l 1 co
p,J A
(pease print)
ILI Signature / f Title G��� r-
DOH-1555(o7/18)p 1 of 2
1.. :r .
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#