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Norris, Betty NEW YORK STATE DEPARTMENT OF HEALTH 35 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Betty Lee Norris Female Date of Death Age If Veteran of U.S. Armed Forces, July 27, 2016 74 War or Dates I— Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death Friki Natural Cause Accident ❑ Homicide 0 Suicide Undetermined ❑ Pending Circumstances Investigation W Medical Certifier Name Title CI Michael Fuller, M.D Address 100 Park Street Glens Falls, NY 12801 Death Certificate Filed District Number Regis ' ber City, Town or Village ��/ J o ❑Burial Date Cemetery or Crematory July 29, 2016 Pine View Crematorium Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed ❑ Removal and/or Held • and/or Address H' Hold Date Point of eL ❑Transportation Shipment CO by Common Destination CI Carrier ElDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom i— Remains are Shipped, If Other than Above 2 Address W CL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued "2/ Zc J /6 Registrar of Vital Statistics (signature) District Number S 60 Place G (sue S P1. k\ SJ &) I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W, Date of Disposition 07/29/2016 Place of Disposition Quaker Road Queensbury,NY 12804 (address) C c (section) (lot number) (grave number) n` Name of Sexton or Person in Charge o Premises n ., -54041 W � (please print) Signature Title (over) DOH-1555 (02/2004)