Normile, Richard NEW YORK STATE DEPARTMENT OF HEALTH .,
11 70(
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Richard L Normile Male
Date of Death Age If Veteran of U.S. Armed Forces,
09/21/2015 80 years War or Dates 1955 -57
}•- Place of Death Hospital, Institution or
City, TRIOCXr MAW Glens Falls Street Address Glens Falls Hospital
Manner of Deathirl Natural Cause El Accident El Homicide El Suicide n Undetermined ri Pending
Circumstances Investigation
W Medical Certifier Name Title
Amy Hogam- Moulton M. D.
Address
102 Park Street Glens Falls, N Y 12801
Death Certificate Filed District Number Register Number
City, TIOGOirVXDUSX Glens Falls 5601 468
❑Burial Date Cemetery or Crematory
09/24/2015 Pine View Crematorium
❑Entombment Address
[Cremation Oueensbury, NY 12804
Date Place Removed
❑Removal and/or Held
Q11F= and/or Address
U) Hold
O Date Point of
Q Transportation Shipment
0 by Common Destination
Carrier
El
Disinterment Date Cemetery Address
El Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home, Inc. 00448
Address
7 Sherman Ave. Corinth, NY 12822
Name of Funeral Firm Making Disposition or to Whom
F Remains are Shipped, If Other than Above
2 Address
CC
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/22/2015 Registrar of Vital Statistics i,N-1C W
signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition M s 11 T Place of Disposition ? U 'J G orw-.
W (address)
Cl)
CC (section) �` (lot number (grave number)
dName of Sexton or Person in Char, a of Premises �t"^mil
�► (please print)
Signature Title (l gir
(over)
DOH-1555 (02/2004)