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Nadeau, Normand r f V NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Normand Laurent Nadeau Male =x ; Date of Death Age If Veteran of U.S. Armed Forces, °° June 30,2016 83 War or Dates Korean Place of Death Hospital, Institution or City, Town or Village Fort Ann Street Address 1695 Pilot Knob Rd. Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending Itt Circumstances Investigation a Medical Certifier Name gl.' Thomas Pontuese MD Address % = 100 Broad St.,Glens Falls,NY 12801 Death Certificate Filed District Number Register Number .�= City, Town or Village S7S y ❑Burial Date Cemetery or Crematory ❑Entombment July 5,2016 Pine View Crematory Address ©Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed ZZ n Removal and/or Held and/or Address —I— Hold Cl) O Date Point of NTransportation Shipment p by Common Destination Carrier n Disinterment Date Cemetery Address n Reinterment Date Cemetery Address Permit Issued to Registration Number ;.' Name of Funeral Home Alexander-Baker Funeral Home 00037 Address -:, 3809 Main Street,Warrensburg,NY 12885 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above • Address 14 Permission is hereby granted to dispose of the human rem ns described abo e-a indicated. Date Issued OS1 �� Registrar of Vital Statistics .% ._ . � (signature) District Number 5.7s / Place �'/��,1- LG•ii kt '7/ L1 /2 I certify that the remains of the decedent identified above were disposed ofZttl,/ inaccordance with this permit on: tu Date of Disposition 7/6116 Place of Disposition 4Ye1P--. W (address) CO LY (section) (lot fiber) (grave number) pName of Sexton or Person in Charge of Premises G'�il .._1+�-ld� 'Z (please print) Signature j t 4____ Title r eftl .TPL (over) DOH-1555 (02/2004)