Lambert, Norman NEW YORK STATE DEPARTMENT OF HEALTH 6 Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Norman W. Lambert Male
Date of Death Age If Veteran of U.S. Armed Forces,
May 28, 2012 91 War or Dates
°: Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
,i Manner of Death n Natural Cause n Accident n Homicide [ Suicide -Undetermined Pending
AU Circumstances Investigation
t g Medical Certifier Name Title
Eg Marvin Davidowitz,MD
::: Address
100 Park Street,Glens Falls,NY 12801
:: Death Certificate Filed District Number Register Number
..
City, Town or Village Glens Falls 5601 -2-. Ul L4
❑Burial Date Cemetery or Crematory
❑Entombment May 30,2012 Pine View Crematorium
Address
®Cremation 21 Quaker Road,Queensbury,NY 12804
Date Place Removed
ZZ n Removal and/or Held
and/or Address
H Hold
N
0 Date Point of
W 0 Transportation Shipment
a by Common Destination
_ Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan&Denny Stafford Funeral Home 01443
r:::f: Address
�k;
eo; 53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
gi
_u , Permission is hereby granted to dispose of the human remains described above as indicated.
6;
Date Issued Si 3 6//D Registrar of Vital Statistics L3C Q W
(signature)
.. District Number 5601 Place Glens Falls, Ar V 12 10
F- I certify that the remains of the decedent identified above were disposed of in accordance� with this permit on:
�Z V C.t �rw
Date of Disposition S)31)iz Place of Disposition ��.. ut,.,
W (address)
Cl)
Q0 (section) I (lot number) (grave number)
Name of Sexton or Person in Charge of Premises �Ar,� r -( b1 '
Z (please print)
W
Signature 41-0.-- �- Title l d0,
(over)
DOH-1555(02/2004)