Norman, Abraham Gabriel @, 4 iiii
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Abraham Gabriel Norman Male
Date of Death r Age If Veteran of U.S.Armed Forces,
05/24/2022 81 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Ticonderoga Town Street Address Elderwood at Ticonderoga
Ili
p Manner of Death El Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
CI James Gabler PA
Adeess
1019 Wicker St,Ticonderoga Tbwn,New York 12883
Death Certificate Filed Town Of Ticonderoga District Number Register Number
,Town or Village Cie 1564 22
Burial Date Cemetery,Crematory or Facility Name
05/2512 Pine View Crematorium
Entombment Addrer;sRR
Cremation Queensbury Town,New York
Donation
OZ❑Removal Date Place Removed
and/or and/or Held
H Hold Address
U)
0
d Date Point of
(J) Transportation
p by Common Shipment •
Carrier Destination
ElDisinterment Date Cemetery Address
El Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
2 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/25/2022 Registrar of Vital Statistics Tonya M Thompson(E1 ctronica1ySigned)
(signature)
District Number 1564 Place Town Of Ticonderoga
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition J I 2(,0 ji1_. Place of Disposition .�,,IL.. i1MI
2 (address)
uJ
CO (sedion) ` (lot number) (grave number)
aName of Sexton or Person in Cha f Premises G (`1 M���
Z p tease print/
W Signature Title ( 09K
DOH-1555(o7/18)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 on burial permit
Official Funeral Directors Reg.or License#