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Vogelsang, Nancy Ruth NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Nancy Ruth Vogelsang •- Female Date of Death Age If Veteran of U.S.Armed Forces, 09/30/2023 77 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Bolton Town Street Address 85 Rainbow Beach Road, Bolton Town,New York 12824 p• Manner of Death []Natural Cause Accident Homicide Suicide Undetermined nPending V I I Circumstances II Investigation W Medical Certifier Name Title G Lynn Keil PA Address 1340 State Route 9,Lake George Town,New York 12845 Death Certificate Filed Town Of Bolton District Number Register Number City,Town or Village 5650 13 ▪Burial Date Cemetery,Crematory or Facility Name 10/03/2023 Pine View Crematory D Entombment Address ©Cremation Queensbury Town,New York ▪Donation 0❑Removal Date Place Removed and/or and/or Held H Hold Address 0 d Date Point of Cl) Transportation CI Common Shipment Carrier Destination O Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom I— Remains are Shipped,If Other than Above Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date issued 10/03/2023 Registrar of Vital Statistics Jodi Petteys(Electronically Signed) (signature) District Number 5650 Place Town Of Bolton I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H n 1 WDate of Disposition /O-6-ZOZ 1 Place of Disposition ,JQ �,e',,J 2 (a dress) W CC CC (section) _ (lot number) (grave number) 8 Name of Sexton or Person in Charge remi s t\ll c'/r10,4 J Z l(peaasse print) W Signature Title OP� 'TW DOH-1555(o7/18)p t of 2 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#