Mastandrea, Norma . ,-, 411,, . 1z3g
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Norma Mastandrea Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/21/2020 91 Years War or Dates
i_ Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation
IJJ
p Manner of Death El Natural Cause 0 Accident 0 Homicide Ei Suicide 11 Undetermined 11 Pending
W Circumstances Investigation
0 W Medical Certifier Name Title
0 Kenneth France MD
• Address
170 Warren St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 527
Burial Date Cemetery,Crematory or Facility Name
11/24/2020 Pine View Crematory
Entombment Address
0 Cremation Queensbury Town,New York
11 Donation
Date Place Removed
Removal and/or Held
H and/or
N
Hold Address
0
a Date Point of
v.) ❑Transportation Shipment
p by Common
Carrier Destination
0 Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
F Remains are Shipped,If Other than Above
-- Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/24/2020 Registrar of Vital Statistics ??p6ert/7rufrewCurtu'glectronicaQSrgne4
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
Z Date of Disposition /--.Z8-2vzi7 lace of Disposition ' "ili
~addres Zter---•
s/
W
NCC (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of P miser C���p �� i�
o /p/e e print)
IllSignature /� Title (IVAIVX
DOH-1555(o7/18)p 1 of 2
Public Health Law Sec. 4145(2b) - 3® '-
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#