Norton, Fred NEW YORK STATE DEPARTMENT OF HEALTH 4 ' '' 4 y66,
Vital Records Section Burial - TransitP r emit
` Name First Middle Last Sex
Fred Curtis Norton Male
Date of Death Age If Veteran of U.S. Armed Forces,
June 8,2017 46 War or Dates
{{.... Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
pManner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
In Circumstances Investigation
w Medical Certifier Name Title
0 Adams Dr.
Address
Glens Falls Hospital,Glens Falls,NY 12801
Death Certificate Filed District Number Regier Nber
City, Town or Village Glens Falls 5601
❑Burial Date Cemetery or Crematory
June 12,2017 Pine View Crematory
ElEntombrnent Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
t Hold
U)
0 Point of Shipment Point of
NTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
1
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
, Address
to
ttt
4 Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 6 1 (2i 17 Registrar of Vital Statistics LA-)C;.,;L ‘..a
(signatu
District Number -6 0 j Place 6 (52„,...S F-6, 'Os N y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition (p 113 I11 Place of Disposition f„ta., Cvm'et° ,,_..
2 (address)
W
N
(section) lot number) (grave number)
O Ap Name of Sexton or Person in Charge o Premises . Gr St-�1(r~
Z (ple se print)
w Signature Title CRV4191,-
(over)
DOH-1555 (02/2004)