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Fuller, Norman P. .6 107, NEW YORK STATE DEPARTMENT OF HEALTH • ' ' Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Norman P Fuller Male Date of Death Age If Veteran of U.S.Armed Forces, 01/25/2021 50 Years War or Dates H Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address Glens Falls Center for Rehabilitation and Nursing p Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ElUndetermined Pending Circumstances Investigation W Medical Certifier Name Title a Michael Miles MD Address 152 Sherman Ave,Queensbury Town,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 33 Burial Date Cemetery,Crematory or Facility Name 01/27/2021 Pine View Crematory ❑Entombment Address 0 Cremation Queensbury Town,New York ElDonation Q�Removal Date Place Removed and/or and/or Held pN Hold Address (0 LI Transportation Date Point of by Common Shipment Carrier Destination EIDisinterment 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 Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom } Remains are Shipped,If Other than Above 2 Address OC W C' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/27/2021 Registrar of Vital Statistics Caroline Jfildegarde Barber(ECectronicafiySigned) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z , l9 IU Date of Disposition �'2$ ill Place of Disposition .I ' .t ,�� 2 (a dress/ W Q (section/ (lot number) (grave number) gName of Sexton or Person in Charge of remises in r4 � 51444 Z (piece print/ W � Title rt Signature �, DOH-1555(07/18)p 1 of 2 a Public Health Law Sec. 4145(2b) 01441,66 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#