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Nelson, Carol M
11 7-13 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Carol M.Nelson Female Date of Death Age If Veteran of U.S.Armed Forces, 03/20/2023 83 Years War or Dates F.. Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 34 Prospect Drive,Queensbury Town, New York 12804 p Manner of Death El Natural Cause Accident El Homicide Suicide Undetermined Pending lL Circumstances Investigation WC• Medical Certifier Name Title Aimee Mcmaster NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 38 Burial Date Cemetery,Crematory or Facility Name 03/21/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation oRemoval Date Place Removed and/or and/or Held - Hold Address CO 0 O. Date Point of U) Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above Address tu a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/21/2023 Registrar of Vital Statistics Caroline/-(i(degarde Barber(ECectronicallySigned) (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: H Z Date of Disposition lL 31 L.311..7 Place of Disposition ,,� 2 (address) W tl) Q (section) (lot number) f" (grave number/ O Name of Sexton or Person in Charge of r miles �r• L_ z (please print)-( Lu L POO C Signature Title DOH-1555(07/18)p 1 of 2 6822 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#