Loading...
Fortune, Nancy Thompson / vII YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit ,ureau of Vital Records Name First Middle Last Sex Nancy Thompson Fortune Female Date of Death Age If Veteran of U.S.Armed Forces, 07/30/2023 80 Years War or Dates 1961-1962 i_ Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital p• Manner of Death Z Natural Cause Accident El Homicide ESuicide FlUndetermined EiPending W Circumstances Investigation ✓ Title W Medical Certifier Name O Scott Biasetti MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Registe, /ber City,Town or Village 5601 359 Burial Date Cemetery,Crematory or Facility Name IIIIIMM 07/31/2023 Pine View Crematorium Entombment — Address ©Cremation Queensbury Town,New York Donation ❑and/or Removal Date Place Removed and/or Held H Hold Address N 0 G. Date Point of U) Transportation Shipment p by Common Carrier Destination Date Cemetery Address nDisinterment Date Cemetery Address n I Reinterment Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom i— Remains are Shipped,If Other than Above 2 Address CC W t' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/31/2023 Registrar of Vital Statistics Megan.No1in(ECectronica1CySigned) (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: Z W Date of Disposition 7-31 e} ,p Oz3 Place of Disposition ;),V._ It,, Lv LCe. y a k ry 2 (address) W N CC (section) (lot number) (grave number)S Name of Sexton or Person in Charge of Premises J 2 I)"'4..t' Szy -k,S (please print) W Signature"76,, Title Crer"`< .k'C 'DO H-1555(07/18)p 1 of 2 ri 1 7 1 C. ; K.,. Public Health Law Sec. 4145(2b) Receipt Human remains of , delivered on / , 20 • Pine View Cemetery Representing(he funeral home named.on buriatgermit - • Official Funeral Directors Reg.or License#/