Findlay, Norma .y 11 q
NEW YORK STATE DEPARTMENT OF HEALTH 153
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
_' Norma Willene Findlay Female
Date of Death Age If Veteran of U.S. Armed Forces,
12/10/2017 101 Years War or Dates
Place of Death Hospital, Institution or
-x-' City, Town or Village Granville Village Street Address Indian River Rehabilitation And Nursing Center
Manner of Death a Natural Cause ❑Accident ❑Homicide ❑Suicide ❑ Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
`' Sean Bain MD
Address
17 Madison St,Granville Village,New York 12832
Death Certificate Filed District Number Rer >r Number
City, Town or Village Granville Village 5725 40
El Burial Date Cemetery or Crematory
12/12/2017 Pine View Crematory
❑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
Carrier
Date
Disinterment Cemetery Address
Date
El Reinterment 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
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
T Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/12/2017 Registrar of Vital Statistics Richard&berts fCectronicaaySigned
(signature)
District Number Place
5725 Granville Village, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
�=g 1 �
Date of Disposition J2 J 13 in Place of Disposition T p rn.1/,�- /0. tom.
(address)
1.
(section) (lot number) (grave number)
i
Name of Sexton or Person in Charge of Premises ., S s
( lease print)
Signature 21 ,J--1. Title l'afrtR'ig
(over)
DOH-1555 (02/2004)