Normandin, Philip NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section A Burial - Transit Permit
Name First Middle Last Sex
Philip Michael Normandin Male
Date of Death Age If Veteran of U.S. Armed Forces,
5/23/2018 72 War or Dates n/a
E, Place of Death Hospital, Institution or
Z City, Town or Village Moreau Street Address 13 Meadow Drive
W Manner of Death I Xi Natural Cause n Accident n Homicide n Suicide ❑Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
CI Andrew Garner,MD
Address
Glens Falls,Ny
Death Certificate Filed District lil mbeer Register Number
City, Town or Village Moreau O
❑Burial Date Cemetery or Crematory
❑Entombment May 29,2018 Pine View Crematorium
Address
®Cremation J 51 Quaker Road,Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
N
O Date Point of
W ❑Transportation Shipment
p by Common Destination
Carrier
❑Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
I- Remains are Shipped, If Other than Above
g Address
tZ
n. Permission is here y granted to dispose of the human re • descri d a ove as indicated.
Date issued 1' Registrar of Vital Statistics O� 4
L`
(s )turn)
(C�District Number , `(YD Place -715 idyl O f /L-1062,7/
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
6 Date of Disposition 5:4-:P9,' Place of Disposition R,Uj wet,,,, ele/+tadari✓ram
W (address)
CO
re (section) (lot number) (grave number)
p /,�Name of Sexton or erson 'n Charge of Premises Si.f„/ U,4,,viiSS t
Z (please print)
W Signature f...„� Title CO.er,ta.-f et
(over)
DOH-1555(02/2004)