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Bowdy, Norma 1 I. 4 71R NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex r Norma V. Bowdy Female FA Date of Death Age If Veteran of U.S. Armed Forces, r F r December 1, 2014 84 War or Dates n/a Place of Death Hospital, Institution or City, Town or Village Town of Horicon Street Address 654 East Shore Drive Manner of Death Natural Cause n Accident n Homicide piSuicide n Undetermined n Pending Circumstances Investigation Medical Certifier Name Title Harriet Busch,MD ri Address Queensbury,NY Death Certificate Filed District Number Register Number f it City, Town or Village Town of Horicon 5' ❑Burial Date Cemetery or Crematory December 2,2014 Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road, Queensbury,NY 12804 Date Place Removed ZZ 7 Removal and/or Held 2 and/or Address H Hold th 0 Date Point of Nn Transportation Shipment p by Common Destination Carrier n Disinterment Date Cemetery Address Reinterment Date Cemetery Address ''`' Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Road,Queensbury,NY 12804 Name of Funeral Firm Making Disposition or to Whom ; Remains are Shipped, If Other than Above II: Address Permission is hereby granted to dispose of the human rema' s described abo a as indicate . .`,:',, ��- /_1L '''; Date Issued � � Registrar of Vital Statistic '-' ' ( r ;, (signature) District Number ga6-2--/ Place Town of Horicon eft° I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition (1- 4-04 Place of Disposition Z�V�,,, L r—d"oc ram" 2 (address) W CO (section) (lot number) (grave number) pName of Sexton or Person in Charge of Premises L(.r7rcrx. Stovf Z ,/ (pleake print) W Signature 4.- /L Title (over) DOH-1555(02/2004)