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Brown, Norma Izo NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Norma M Brown Female Date of Death Age If Veteran of U.S.Armed Forces, 11/16/2020 92 Years War or Dates �.. Place of Death Hospital,Institution or W City,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc p Manner of Death ©Natural Cause ❑Accident ❑Homicide El Suicide 0 Undetermined 0 Pending W Circumstances Investigation U Medical Certifier Name Title a Diane Westbrook NP Address 131 Lawrence St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 580 Burial Date Cemetery,Crematory or Facility Name 11/18/2020 Pineview Crematory ElEntombment Address ElCremation Queensbury Town,New York ❑Donation ElRemoval Date Place Removed and/or and/or Held N Hold Address 0 Date Point of U) ❑Transportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 2 Address Q W a" Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/17/2020 Registrar of Vital Statistics John Paul Franck(Electronically Signed) (signature) District Number 4501 Place Saratoga Springs, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition Ilia 110 Place of Disposition 2 (address) W CC U) (sertkm) (lot number) (grave number) g Name of Sexton or Person in Charge of Premis (p1 ase print W Signature Title fvi4+i1Vi DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 014 212 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#