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Donohue, Nancy LCF)N ' it 7% NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle . Last Sex Nancy Donohue Female Date of Death Age If Veteran of US.Armed Forces, 02/29/2024 91 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Hudson Falls Village Street Address 17 Spruce Street, Hudson Falls Village, New York 12839 LU p Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation C) W Medical Certifier Name Title C John Stoutenburg MD Address 100 Park St,Glens Falls,New York 12801 4 Death Certificate Filed Village Of Hudson FallS District Number Register Number City,Town or Village 5726 10 Burial Date Cemetery,Crematory or Facility Name ...' 03/02/2024 Pine View Crematorium Entombment _ Address ©Cremation Queensbury Town,New York Donation ZZ❑Removal Date Place Removed and/or and/or Held F- Hold Address N 0 lL Date Point of U)OTransportation Q by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment 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 1— Remains are Shipped,If Other than Above a Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/01/2024 Registrar of Vital Statistics Cynthia Bardin(ECectronicallySigned) (signature) District Number 5726 Place Village Of Hudson Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: II— I Date of Disposition 31� IN Place of Disposition 1Q T'J >�vcc i tv5mA 2 (address) W CO CC (section) IJ 4 (lot number) (grave number) O Name of Sexton or Person in Charge of Premises °1�fl, lit Z 2 I (please print) W Signature Title ( N DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt 1 Human remains of 1 delivered on , 20 3 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#