Normandin, Lionel NEW YORK STATE DEPARTMENT OF HEALTH' -
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Lionel Meridith Normandin Male
Date of Death Age If Veteran of U.S. Armed Forces,
= March 21, 2015 78 War or Dates n/a
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death ❑X Natural Cause Accident ❑Homicide n Suicide Undetermined n Pending
W Circumstances Investigation
ui Medical Certifier Name Title
13 Dr Robert Sponzo,MD
Address
Glens Falls,NY
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls,NY 5601
❑Burial Date Cemetery or Crematory
March 23, 2015 Pine View Crematorium
❑Entombment Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
ZZ Removal and/or Held
and/or Address
E Hold
N
0 Date Point of
NI I Transportation Shipment
p 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
Address
53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
I Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 3123) 5 Registrar of Vital Statistics oGV.,yv-2.
(signature
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 3-2i-/ Place of Disposition Pr%a V, Cw'
W (address)
(section) Anumger) (grave number)
Name of Sexton o er harge of Premises t� d
/( i7J1/ &Signature ; � Title AS.
(over)
DOH-1555(02/2004)