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Gregson, Norma Mae ? zz NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Norma Mae Gregson Female Date of Death Age If Veteran of U.S.Armed Forces, 08/26/2021 96 Years War or Dates . Place of Death Hospital,Institution or Z City,Town or Village Johnsburg Town Street Address Elderwood at North Creek pManner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending U Circumstances Investigation LLI G Medical Certifier Name Title James Hindson MD Address 112 Ski Bowl Rd,Johnsburg Town,New York 12853 Death Certificate Filed District Number Register Number City,Town or Village North Creek 5655 32 ❑Burial Date Cemetery,Crematory or Facility Name 08/28/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation Removal Date Place Removed - and/or and/or Held H- Hold Address CO 0 O. 1-1 Date Point of (/) ❑Transportation p by Common Shipment Carrier Destination Date Cemetery Address El Disinterment ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. , Date Issued 08/27/2021 Registrar of Vital Statistics ?Cathleen C.Gorak(ECectronicafy Signed) (signature) District Number 5655 Place North Creek, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IF- W Date of Disposition 2�• art/ Place of Disposition 2 (address) W CC CC (section) (lot number) (grave number) 8 Name of Sexton or Pers in Charge of Premises y � `� �'+'t� e (please print) W Signature Title "�m 5 �u�� DOH-1.555(07/t8)p 1 2 n 8 Public Health Law Sec. 4145(2b) Receipt , , Human rernain of delivered on , 20 --Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#