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Norton, Leonard ivtvv YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex thl Leonard Sidne Norton Male " Date of Death Age If Veteran of U.S. Armed Forces, 01 March 4, 2011 69 War or Dates 1 'j Place of Death Hospital, Institution or friT City, Town or Village Queensbu Street Address 19 Minnesota Ave 14 Manner of Death 0 Natural Cause 0 Accident D Homicide Suicide 0 Undetermined ri Pending Circumstances Investigation Medical Certifier Name Title Paul F Bachman MD, Address Warrensburg Health Center Warrensburg, NY 12885 0.0 Death Certificate Filed Di ' Nwnb- R . er Number Cit , Town or Village !.''0 Burial Date Cemetery or Crematory March 11, 2011 Pine View Crematorium ❑Entombment Address .,©Cremation Quaker Road Queensbury,NY 12804 Removal Date Place Removed and/or and/or Held Hold Address WEST GLENS FALLS 44 Date Point of Transportation Shi.ment by Common Destination Carrier .s Disinterment Date Cemetery Address Reinterment Date Cemetery Address*El gin:_- Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00276 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 Remains are Shipped, If Other than Above "` Address --,-- ',K1 Permission is hereby granted to dispose of the human1r9Inains described ove as indicated. b I Registrar of Vital Statistics q , Date Issue- j g G---� A,c1 (signature) District Number S(0 f Place 6 C l • • tr„ ■ i 7 I certify that the remains of the decedent identified above were dispo d of in acc.:dance ith this permit on: i;t Date of Disposition 3-N I( Place of Disposition Pre. LQW ('f%-c o+ > i (address) �:s, 1,, (section) (lot numbe (grave number) ; , Name of Sexton or Pe on in Charge of Premises ac-,sATL-- ..y+•t(r- (please print) Signature , / '� Title OFvlh1*rck (over) DOH-1555 (02/2004)