Munro, Norman NEW YORK STATE DEPARTMENT OF HEALTH 11 Yr
Vital Records Section - Burial - Transit Permit
Name First Middle Last Sex
Norman McAinsh Munro Male
Date of Death Age If Veteran of U.S. Armed Forces,
June 16, 2015 82 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Fort Edward Street Address Fort hudcsoirnNursing Home
Manner of Death E Natural Cause El Accident ❑ Homicide ❑ Suicide Undetermined ❑ Pending
cumstances Investigation
Medical Certifier Name Title
Bernardo R Villajuan, Dr.
Address
161 Carey Road Queensbury, NY 12804
At
Death Certificate Filed District Number Register Nuer
City, Town or Village Fort Edward (�
❑Burial Date Cemetery or Crematory
June 17, 2015 Pine View Crematory
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
J ❑ Removal and/or Held
and/or Address ,.
Hold
z' Date Point of
.;
I:Transportation Shipment
by Common Destination
Carrier _
❑ Disinterment Date =_� Cemetery Address
❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home- FE 01079
V Address
82 Broadway, Fort Edward NY 12828
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Fa:
Permission is here y granted to dispose of the human r ins ile bed?boYe indicated.
Date Issued Registrar of Vital Statistics U
ni 4-1 (signature)
District Numbers5') Place 1(1}7k 06 Ed1A,J
x
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 06/17/2015 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) ilot number) (grave number)
Name of Sexton or Person in arge Premises �,1� Stv*'�
(please print)
Signature Title 1126"'I7t!-+
(over)
DOH-1555 (02/2004)