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Robinson, Nancy Carol LC (*II NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Nancy Carol Robinson Female Date of Death Age If Veteran of U.S.Armed Forces, 11/24/2023 90 Years War or Dates i_ Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address Glens Falls Center for Rehabilitation and Nursing p Manner of Death Q Natural Cause Accident ri Homicide El Suicide nUndetermined n Pending W Circumstances Investigation U W Medical Certifier Name Title O Elizabeth Bessette NP Address 152 Sherman Ave,Queensbury Town,New York 12801 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 179 Burial Date Cemetery,Crematory or Facility Name °... 11/29/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York DDonation 60Removal Date Place Removed and/or and/or Held H Hold Address f) 0 a Date Point of Cl)❑Transportation Shipment Es by Common Carrier Destination Ei Disinterment Date Cemetery Address Date Cemetery Address Reinterment Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom f— Remains are Shipped,If Other than Above g Address CC W 0- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/29/2023 Registrar of Vital Statistics Caroline 9 ii gard Barher(Electronicall:y Signed) (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: W Date of DispositionI— I1130�T Place of Disposition �ZOVO;E w C/v�MA'LO ZI/� 2 (address) W Cl)Q (section) (lot number) s_s— (grave number) gName of Sexton or Person in Charge of Pr es delL......... t+n t t it z1] ease print) W Signature (/ Title ` A4 RQ DOH-1555(07/18)p 1 of 2 I % 7 7 , 1 Public Health Law Sec. 4145(2b) ' �^ l i �., `..., Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# i