Carr Sr., Norman r
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Norman E Carr Sr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
F. November 26, 2018 81 War or Dates 1958-1962
2 Place of Death Hospital, Institution or
W City,Town, or Village Whitehall (Street Address Home
a Manner of Death C Natural Cause ❑ Accident I I Homicide (Suicide ❑ Undetermined n Pending
W Circumstances Investigation
U Medical Certifier Name Title
W Dr. Kerin M Devlin, M.D. RNP
Q Address
68 Poultney Street, Whitehall, NY 12887
Death Certificate Filed District Number Register Number
City,Town or Village Whitehall `7b
n Burial Date Cemetery or Crematory
November 29, 2018 Pineview Crematorium
❑Entombment Address
Cremation 21 Quaker Road Queensbury, NY 12804
Date Place Removed
0 n Removal and/or Held
and/or Address
1- Hold
-
0 Date Point of
0 I1 Transportation Shipment
d by Common Destination
Carrier
Date Cemetery Address
an Disinterment
❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Jilison Funeral Home, Inc. 00885
Address
46 Williams Street, Whitehall, New York 12887
~ Name of Funeral Firm Making Disposition or to Whom
2 Remains are Shipped, If Other than Above
re
111 8. Address
Permission is hereby granted to dispose of the human remain scribed abg. e as.indicated.
Date Issued /%/ 8 c/6- Registrar of Vital Statistics a f`/
rilAVAI
(signature)
District Number `�7/P 4, Place Whitehall,New York
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
w Date of Disposition 11/29/2018 Place of Disposition Pineview Crematorium
2 (address)
In
p (section (lot number) (grave number)
• Name of Sexton or Person in Charge of Premises C-rr^e•Y 5I,;rc.S
2 (please print)
Signature % .� d Title CAst"rdo
(over)
DOH-1555 (02/2004)