Normile, William . 1
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
William T Normile Male
Date of Death Age If Veteran of U.S. Armed Forces,
10/21/2017 84Years War or Dates 1953-55
°F Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Death EXJ1 Natural Cause ❑Accident 0 Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
IC
Medical Certifier Name Title
Romel Gobunsuy MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
kit
City, Town or Village Saratoga Springs 4501 523
ii0 Burial Date Cemetery or Crematory
10/27/2017 Pineview Crematory
la Li Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
oe CarrierIV _
❑Disinterment Date Cemetery Address
El Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
Address
7 Sherman Ave,Corinth,New York 12822
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
R, Date Issued 10/24/2017 Registrar of Vital Statistics yohn 1'Franck, Eiecimicarcysigned-
(signature)
ti
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition Ili 27),1 Place of Disposition Pileki-- e. or0-1
(address)
(section) (lot number) C (grave number)
Name of Sexton or Person in Charge of Premises t,4 J Wit-
,, (p se print)
I. Signature di
Title f e,11 A Pt
(over)
DOH-1555(02/2004)