Stevenson, Nancy Lynne NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Nancy Lynne Stevenson Female
Date of Death Age If Veteran of U.S.Armed Forces,
02/16/2024 61 Years War or Dates
i_ Place of Death Hospital,Institution or
Z City,Town or Village Granville Village Street Address Haynes House of Hope
W W Manner of Death Natural Cause Accident ri Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
O Curtis Gedney MD
Address
454 Glen Street,Glens Falls,New York 12801
Death Certificate Filed Town Of Granville District Number Register Number
City,Town or Village 5756 9
Burial R
Date Cemetery,Crematory or Facility Name
02/20/2024 Pine View Crematorium
Entombment Address
nCremation Queensbury Town,New York
Donation
O n Removal Date Place Removed
and/or and/or Held
1--
N Hold Address
0
d Date Point of
N 7Transportation
p by Common Shipment
Carrier Destination
nDisinterment
Date Cemetery Address
pi 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
_ 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 02/20/2024 Registrar of Vital Statistics Jenny Linda Sit Ilarte1Ce(ECectronicaffy Signed)
(signature)
District Number 5756 Place Town Of Granville
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 212212y Place of Disposition L
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2 (address)
W
Cl)EC (section) (lot number) (grave number)
ill0 Name of Sexton or Person in Charge of P s nl�p� 1rw�
Z (plea print) r,
illSignature Title G "'n'"Y
DOH-1555(07/18)p 1 of 2
1
� I ;
Public Health Law Sec. 4145(2b)
1
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#