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Norton, Laurence Royal gLg NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Laurence Royal Norton Male Date of Death Age If Veteran of U.S.Armed Forces, 10/13/2021 82 Years War or Dates 1961-64 Place of Death Hospital,Institution or Z City,Town or Village Milton Town Street Address Gateway House of Peace p Manner of Death © Natural Cause ❑Accident El Homicide ❑Suicide 0 Undetermined 0 Pending W Circumstances Investigation W Medical Certifier Name Title p Howard Silverberg MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Ballston Spa 4561 60 ❑Burial Date Cemetery,Crematory or Facility Name 10/18/2021 Pine View Crematory Entombment Address X❑Cremation Queensbury Town,New York ❑Donation ZO ❑Removal Date Place Removed and/or and/or Held F- Hold Address 0 Q. Date Point of co ❑Transportation by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls, New York 12803 Name of Funeral Firm Making Disposition or to Whom F- 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 10/18/2021 Registrar of Vital Statistics Brenda.?fowe(ECectronicalty Signed) (signature) District Number 4561 Place Ballston Spa, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition ! II ZI Place of Disposition A— (,,. 0.,.1 2 (address) W CC N (section) (lot num (grave number) g Name of Sexton or Person in Charge o r mises 41,rit Z (please print) W Signature Title 0601C DOH-1555(07/18)p t of 2 i Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#