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Fuller, Nancy 4 t It Jo {. NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Nancy Fuller Female Date of Death Age If Veteran of US.Armed Forces, 03/19/2023 75 Years War or Dates F Place of Death Hospital,Institution or WCity,Town or Village Hadley Town Street Address 6305 Route 9 N,Hadley Town,New York 12835 a Manner of Death IZI Natural Cause ❑Accident Homicide n Suicide FlUndetermined El Pending 111.1 Circumstances Investigation UJI G Medical Certifier Name Title Jennifer Hayes MD Address 200 Smith Drive,Corinth,New York 12822 Death Certificate Filed., wn Of Hadley District Number Register Number Cit'c Town or Village 4558 2 Burial Date Cemetery,Crematory or Facility Name wow 04/05/2023 Pineview Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation a❑Removal Date Place Removed and/or and/or Held -- Hold Address 0 CI. Date Point of CICTransportation 5 by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom p- Remains are Shipped,If Other than Above a Address CC W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/21/2023 Registrar of Vital Statistics Colleen Demarsh(Electronically Signed) (signature) District Number 4558 Place Town Of Hadley I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ZW Date of Disposition 11171 73 Place of Disposition .:\/ pn..—, 2 (address) w N (section) /!at number) (grave number) Name of Sexton or Person in Charge of Pre ises /A r� l_ w.l(r W �,� / /pie se print/ / Signature <�f ! Title ` 'r'�W�'� DOH-1555(07h8)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of • delivered on , 20 Pine View Cemetery Representing thefuneral honze-narrted on burial permit Official Funeral Directors Reg. or License#