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Englert, Nancy Linda NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Nancy Linda Englert Female Date of Death Age If Veteran of U.S.Armed Forces, 04/03/2023 74 Years War or Dates i— Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 166 Lake Parkway,Queensbury Town,New York 12845 0 Manner of Death ❑X Natural Cause ❑Accident 0 Homicide Suicide FlUndetermined El Pending W Circumstances Investigation W Medical Certifier Name Title C1 Colleen Quinn MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 50 Burial Date Cemetery,Crematory or Facility Name v 04/05/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed - and/or and/or Held H- Hold Address N 0 Date Point of N❑Transportation Shipment p by Common Carrier Destination O Disinterment Date Cemetery Address Date Cemetery Address ❑Reinterment Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom -. Remains are Shipped,If Other than Above g Address 12 W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/04/2023 Registrar of Vital Statistics Caroline J legarrfeBarber(ECectronicalrySigned) (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: f- A �}f z� W Date of Disposition V-6.-2��2 Place of Disposition p e,4) C� dre s) W CC (section) (lot number) (grave number) t ✓i, 8 Name of Sexton or Person in Charg Pre ises � ,t,.,b dot A z (please print) !L Signature / Title t1 6 LS—� DOH-1555(07/18)p 1 of 2 '73 CI Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit icial Funeral Directors Reg.or License#