Loading...
Norton, Randi Lee /o y() NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Randi Lee Norton Female Date of Death Age If Veteran of U.S.Armed Forces, 12/02/2021 37 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital LLJ p Manner of Death © Natural Cause ❑Accident ❑Homicide Suicide El Undetermined El Pending VCircumstances Investigation LU Medical Certifier Name Title CI Shahid Ahmed MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 571 Burial Date Cemetery,Crematory or Facility Name 12/06/2021 Pine View Crematory Entombment Address lCremation Queensbury Town,New York ❑Donation 0 ElRemoval Date Place Removed and/or and/or Held N Hold Address 0 CL N Li Transportation Date Point of p by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom F- Remains are Shipped,If Other than Above 2 Address CC W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/06/2021 Registrar of Vital Statistics cN96ertAndrew Curtis(ECectronicaCCySigned) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: l— W Date of Disposition 'licit' Place of Disposition 2 (address) W CC N (section) (lot number) c. (grave number) Name of Sexton or Person in Charge o Premises tot 1444 Z (pleas print) W Signature Title � ✓ '��� DOH-1555(o7/i8)p 1 of 2 • + i f k { t F4 fl Public Health Law Sec. 4145(2b) Receipt , Human remains of , delivered on , 2 J Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# ,i —*) ?