Norton, Lila L NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Biostatistics Vital Records Section
Name First Middle Last Sex
Lila Luella Norton female
.................... ..............
Date of Death Age If Veteran of U.S.Armed Forces,
2/8/89 74....... War or Dates no
.......... ............ . ....................... ...................... ........................................
:X.....Place... ......o.-fNath
Hospital, Institution or
City,Town or Village City of Glens Falls Street Address Glens Falls Hospital
.......................................
..................*.............. ...... ..... .................. ....... .............. ...... ..... .......
Cause of Death
chronic obstruction pulmonary disease
Medical Cer
tifier............ ..Na...66........ ......................... Tale
it"ie,........ .....................0 MD
Richard Spitzer
............. ...... .............. .............
Address
90 South Street, Glens Falls, N.Y. 12801
......... ............ ................ ........
.... . Registe Death Certificate Filed District Number
�Number
City,Town or Village City of Glens Falls to L
Date Cemetery or Crematory
❑Burial 2/9/1989 Pine Crematorium
................. ................ .. .......... . ......
.......... .......
Address
[Cremation
Town of Queensbury, N.Y.
.......... ....................
Date Place Removed
i0. El Removal
and/or Held
......... ............ ...............
and/or Hold' .........
%.
Address
o................
.. ....... .. .. .... ...................... ............ .........
n. Wife"................. : Point of
Xv [:]Transportation by...
Shipment
M Common Carrier .........
Destination
.......... ......... .......
El Disinterment
Date Cemetery Address
....
Address
........................................
El Reinterment
Date Cemetery dress
Permit Issued to Registration Number
Name of Funeral Firm and Denny Funeral Service, Inc.
02883
......................paaao........... .... .. ....... ............ ........................ ......
_g4
..................... . .............
Address
......................... . ..
12804
..................... .......
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
GG .......................... ............
Address
.Q.:
.............. ........................ ......... .................. ................ .................. ......
Permission Is hereby granted to dispose of the human rem ns described ab Ve as Indicated.
Date Issued Registrar of Vital Statistics (signature)
District Number Place
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition cv,—IC41 _r' Place of Disposition NA 7olfl
W:
Ii (address)
W. (section) (lot number) (grave number)
7 Name of Sexto or PersonU Charge of Premises k P&ZzIlf: 27
i - �ase print) 7o- RZ z�1551 /7/
:UJI: -
Signature Title
DOH-1555(9/86)p 1 of 2(formerly VS-61)