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Normandin, Helen Claire #t1(6 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Helen Claire Normandin Female Date of Death Age If Veteran of U.S.Armed Forces, 02/05/2022 76 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation p Manner of Death ©Natural Cause ❑Accident ❑Homicide 11 Suicide Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title a Courtney Diamond NP Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 83 Burial Date Cemetery,Crematory or Facility Name 02/08/2022 Pine View Crematory ❑Entombment Address ▪Cremation Queensbury Town,New York ❑Donation Z ❑Removal Date Place Removed and/or and/or Held H Hold Address U) ❑Transportation Date Point of S by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address 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 i— Remains are Shipped,If Other than Above a Address W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/08/2022 Registrar of Vital Statistics Megan Nolin(ECectronica1TySigned) (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: Date of Disposition a,—8--a.).., Place of Disposition )1`ne.. )tv-uln) Cji'Z►XQ S/ 2 address) W N (section) (lot number) (grave number) S Name of Sexton or Pe son in Charge of Premises T fA,t,' ) /� (please print) W Signature // .Qil/Y�7`�/ r- Title Cc` {Gr 77 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) �:_ . 5 618 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#