Wrye, Norma Jane NEW YORKSTATE DEPARTMENT OF HEALTH BUriai - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Norma Jane Wrye I Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/06/2019 89 Years War or Dates
E.- Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death �Natural Cause Accident 1:1Homicide Suicide Undetermined Pending
W Circumstances Investigation
U
W Medical Certifier Name Title
Shahid Ahmed MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 482
Burial Date Cemetery,Crematory or Facility Name
11/12/2019 Pine View Crematory
Entombment Address
Lej Cremation Queensbury Town,New York
Donation
Z ❑Removal Date Place Removed
and/or and/or Held
F- Hold Address
N
O
IL Date Point of
Hf Transportation Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
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
Remains are Shipped,If Other than Above
Address
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/12/2019 Registrar of Vital Statistics RP6&/?hdrewCun,&(_-lectrvnicalySigned�
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
h
w
Date of Disposition ri I,31( Place of Disposition 1-i a
Uj (address)
W
N (section) (l umber) (grave number)
cc
GName of Sexton or Person in Charge of Premises
Z C� /P/ease tint/
W Signature Title
DOH-1555(o7/18)p 1 of 2
Public Health Law Sec. 4145(2b) 0 .1.3 0 7 1-
Receipt
Human remains of ; s! delivered on 20_
r
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#