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Norman, Eva M _ . to$ NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Eva M.Norman Female Date of Death Age If Veteran of U.S.Armed Forces, 10/28/2021 ,.,?. ,85Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Milton Town Street Address 910 Rock City Road,Milton Town,New York 12020 W Manner of Death Pending 0 © Natural Cause �Accident �Homicide �Suicide �Undetermined � W Circumstances Investigation W Medical Certifier Name Title 0 Scott Miller PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Ballston Spa 4561 63 Burial Date _ Cemetery,Crematory or Facility Name 10/29/2021 Pine View Crematory ❑Entombment Address ICremation Queensbury,New York ❑Donation ZElRemoval Date Place Removed and/or and/or Held H Hold Address N 0 Date Point of CD Li Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address IDReinterment Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom F. Remains are Shipped,If Other than Above 2 Address W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/29/2021 Registrar of Vital Statistics Brenda Jfowe(ECectronicatTy 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: Z W Date of Disposition II/)1 tl Place of Disposition ��+1,��.- Ad,_ 2 (address) W Cl) (section) //)(lot number) (grave number) CC (1 O Name of Sexton or Person in Charge of Premises Z (pleaSii print) l g(� W �G "_"" Signature Title G DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named op burial permit Official Funeral Directors Reg.or License# /