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Scarincio, Nancy Lee Q ti �Z7 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Nancy Lee Scarincio Female Date of Death Age If Veteran of U.S.Armed Forces, 08/05/2023 82 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ZI Natural Cause Accident El Homicide Suicide FlUndetermined ri Pending W Circumstances Investigation W Medical Certifier Name Title C Howard Silverberg MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 370 HBurial Date Cemetery,Crematory or Facility Name 08/07/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation OZ❑Removal Date Place Removed and/or and/or Held F= Hold Address N 0 d Date Point of (I)❑Transportation Shipment p by Common Carrier Destination ElDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom E— Remains are Shipped,If Other than Above t" Address CC O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/07/2023 Registrar of Vital Statistics Megan Nolin(ECectronicaCCy Signed) (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 Date of Disposition $I Q I 73 Place of Disposition F4-J/,.._, SF— W (address) UJ NCC (section) fir number) (grave number) S Name of Sexton or Person in Charge of Premises r` (H- Z (please intl W P ( Signature Title �� q�� DOH-1555(07/18)p 1 of 2 1 . 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#