Norton, Donald NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section . • Burial - *ran ermit
Name First Middle Last Sex
Donald L. Norton Male
Date of Death Age If Veteran of U.S. Armed Forces,
8/6/2018 76 War or Dates 1963-1967
t- Place of Death Hospital, Institution or
Z City, Town or Village Town of Queensbury NY I Street Address 484 State Route 149,Queensbury,NY
ci Manner of Death I^I Natural Cause ❑Accident E Homicide Li Suicide T Undetermined Pending
W Circumstances Investigation
u i• Medical Certifier Name Title
O John E.Lukaszewicz MD «
Address
84 Broad St.,Glens Falls NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Town of Queensbury,NY S 1,5 I (O
❑Burial Date Cemetery or Crematory ,.
El Entombment August 9,2018 I Pine View Crematorium
Address
®Cremation _ 51 Quaker Road, Queensbury,NY 12804
Date Place Removed
Z ElRemoval and/or Held
and/or Address
H Hold
Cl)
O Date Point of
NI I Transportation Shipment
a by Common Destination
Carrier
n Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
1-, Remains are Shipped, If Other than Above
2 Address
W
W
a
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued g- 8- a0 iy Registrar of Vital Statistics -- 64-1 -4%. Q C9.4._�
(signature)
District Number Ski) 1 Place Q V e.e.nS Io til
I—
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 81 131 IT Place of Disposition illu Le 61EpC, Ln*4to'''''
W (address)
co
0 a (section) (lot number)a , ( (grave number)
p Name of Sexton or Person in Charge of Premises 4 ir,VI_ 14,4'
Z (please print)
Signature 0 J.__ Title ir*Mfiti1
(over)
DOH-1555(02/2004)