Norton, Margaret NEW YORK STATE DEPARTMENT OF HEALTH ;
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Margaret Mary Norton Female
Date of Death Age If veteran of U.S.Armed Forces,
April 2, 2011 78 War or Dates
I— Place of Death Hospital, Institution or
WCity,Town or Village Granville Street Address Haynes House of Hope
CI Manner of Death Ri Natural Cause 1=IAccident OHomicide Suicide I=1 Undetermined 1=1 Pending
Z Circumstances Investigation
W u Medical Certifier Name Title
W Alan Eiseman Primary Care Physician
li Address
160 Allen Street, Rutland,Vermont 05701
Death Certificate Filed District Number Register Number
City Town,Village Granville, NY br15b r1
— El
Burial Date Cemetery or Crematory
Entombment 4-5-2011 Pine View Crematory
Add
Quaker Road,Queensbury,Cremation New York 12804
Date Place Removed
O ❑Removal and/or Held
and/or Address
LA Hold
O Date Point of Shipment
CL
❑Transportation
6 by Common Destination
Carrier
Date Cemetery Address
❑Disinterment
- ElReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Durfee Funeral Home&Cremation Service 023-0001043
Address
P.O.Box 86,119 North Main Street Fair Haven,VT 05743
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped, If Other than Above
2 Address
CC
CL
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued L{`t.i' ,k t Registrar of Vital Statistics ,,
(signature
?3,L „a_.
Place ' kkJn o-I arary I t
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 41 11-5-2011 Place of Disposition Pine View Crematory
LU 21 Quaker Road Queensbury, NY 12804
W (address)
O (section) (lot nu r) (grave number)
p Name of Sexton or p rson in Char a of Premises i A P, y MVO/
Z (please print)
W Signature /1 Title CV 4 4nL
DOH - 1555 (02/2004) (over)