Dobert, Norman NEW YORK STATE DEPARTMENT HEAL'
Vital Records Section Burial - Transit Permit
yo Name First Middle Last Sex
Norman Howard Dobert Male
fi Date of Death Age If Veteran of U.S. Armed Forces,
11/28/2018 86 Years War or Dates 1954-1956
Place of Death Hospital, Institution or
5 a
City, Town or Village Glens Falls ' Street Address Glens Falls Hospital
Manner of Death 0 Natural Cause 0 Accident El Homicide 0 Suicide El Undetermined ri Pending
Circumstances Investigation
Medical Certifier Name Title
Marvin Davidowitz MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 562
E ❑Burial Date Cemetery or Crematory
“ 11/29/2018 Pine View Crematory
' ❑Entombment Address
siCremation Queensbury Town, New York
4. 1
Date Place Removed
Removal and/or Held
and/or Address
Hold
Date Point of
Q Transportation Shipment
by Common Destination
Carrier
0 Disinterment Date Cemetery Address
,
Q 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
r Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
ILPermission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/28/2018 Registrar of Vital Statistics Robert A Curtis(ECectronicalTySigned)
(signature)
lyi 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:
101,4
Date of Disposition )j-Jc-i $ Place of Disposition pipki Vae,w G-- ,q-icrY
(address)
01
arste (section) of number) (grave number)
Name of Sexton or Person in Charge of Premises , c.(M_.% ui Ct5
/ (pi se print)
Signature /i0)" ' iirh Title �,f� o
f (over)
DOH-1555 (02/2004)