Barrett, Norma NEW YORK STATE DEPARTMENT OF HEALTH . i/Lik
Vital Records Section Burial - Transit Permit
Name First M'ddle Last Sex
Norma _ Barrett \ Female
D• ate of Death Age If Veteran of U.S. Armed Forces,
., March 3, 2014 87 War or Dates
t=. P• lace of Death Hospital, Institution or
j._ City, Town or Village Glens Falls Street Address Glens Falls Hospital
CY Manner of Death Natural Cause 0 Accident 0 Homicide 0 Suicide 0 Undetermined Pending
Circumstances Investigation
La' Medical Certifier Name Title
David Foote Md,
Address
e' Rt 4 Hudson Falls, NY 12839
Doh Certificate Filed District Number Register Number
/ own or Village( , n s fez.-!/s 5601 ' 7
Date Cemetery or Crematory
0 Burial March 4, 2014 Pine View Crematorium
0 Entombment Address
a ®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
0 Removal and/or Held
° and/or Address
F Hold
(11 Date Point of
I0 Transportation Shipment
by Common Destination
1, Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
� Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
N• ame of Funeral Firm Making Disposition or to Whom
R• emains are Shipped, If Other than Above
A• ddress
1 .
Wi
, Permission is hereby granted to dispose of the human remains describ De a di d
J,3
Date Issued 03 /y Registrar of Vital Statistics
(signature)
C /-e-%Lb �� %/
District Number 5601 Place AV-s
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
if Date of Disposition 03/04/2014 Place of Disposition Quaker Road Queensbury,NY 12804
;' (address)
l
4,0
f' (section) 1 (lot number) (grave number)
aName of Sexton or Person in Charge o Premises G h0iv' t� �t�++ `
(ease print)
,i Signature 4.-. Title Otempait
(over)
DOH-1555 (02/2004)