Loading...
Whitney, Norma C. NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Norma C.Whitney Female Date of Death Age If Veteran of U.S.Armed Forces, 05/05/2020 89 Years War or Dates II.- Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc W p Manner of Death ©Natural Cause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation U WD Medical Certifier Name Title John Quaresima MD Address 319 Broadway, Fort Edward Town, New York 12828 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 43 Burial Date Cemetery,Crematory or Facility Name 05/05/2020 Pine View Crematory Entombment Address Cremation Queensbury Town, New York Donation ZO Removal Date Place Removed and/or and/or Held ~ Hold Address t!� O d Date Point of N Transportation p by Common Shipment Carrier Destination El Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500, Lake Luzerne, New York 12846 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Otherthan Above 2 Address IX W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/05/2020 Registrar of Vital Statistics A/rTE0MdUW(El6drrnidly99W (signature) District Number 5755 Place Fort Edward, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition _S-2CJ Place of Disposition }�i-he iJ t L 1 GHQ '/,o W (address) W N (section) (lot number) / (grave number) Name of Sexton or Person i ar Pr miser Z (please print) �� 4'�%'YL L Q Gc W Signature Title ' DO H-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 137 12 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#