Engelhard, Norman k \ ' '
NEW YORK STATE DEPARTMENT OF HEALTH , * I
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Norman B. Engelhard Male
Date of Death Age If Veteran of U.S. Armed Forces,
March 4, 2013 83 War or Dates
1: ,_ Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address 27 Petrie Lane
pManner of Death Ix Natural Cause n Accident Li Homicide Suicide n Undetermined Pending
LU Circumstances Investigation
w; Medical Certifier Name Title
Craig Emblidge,MD
Address
Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Queensbury,NY 5657 ono-) rN,
❑Burial Date Cemetery or Crematory
El Entombment March 6, 2013 Pine View Crematory
Address
El Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
N Hold
CO
0 Date Point of
a.
N Transportation Shipment
`p by Common Destination
Carrier
I
Disinterment Date Cemetery Address
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
C
W
2 Permission is hereby granted to dispose of the human r m ins described ab 7 s indicated.
Date Issued �I l2_ JGO?Registrar of Vital Statistics _ q , (� ��
(signature)
District Number 5657 Place Queensbury,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W$ Date of Disposition bl-t3 Place of Disposition R„vu Cee.-4,.—
Lu (address)
N
0 (section) itr.,-koL
number) (grave number)
p Name of Sexton or Person in Char a of Premises St, }
w tease print
Signature 4L.. Title ry
(over)
DOH-1555(02/2004)
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