Hitchcock, Norma J g ,
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Norma J.Hitchcock Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/27/2022 93 Years War or Dates
F Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address Glens Falls Center for Rehabilitation and Nursing
ILI
p Manner of Death ❑x Natural Cause Accident El Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
G Elizabeth Bessette NP
Address
152 Sherman Ave,Queensbury Town,New York 12801
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 139
Burial Date Cemetery,Crematory or Facility Name
..... 09/29/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
NHold Address
0
O. Date Point of
CO❑Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
❑Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped,If Other than Above
2 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/28/2022 Registrar of Vital Statistics Caroline 9ui(egarrfeBar6er(ECectronicallySigned)
(signature)
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition `1171 11Z Place of Disposition 'r•.,..V1..... ( 1Jrc--
W
2 (address)
W
CO
CIC (section) /lot number (grave number)
SName of Sexton or Person in Ch ;of Premises / ro G— It
Z (lease print
W Signature ''� Title tf/nN
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 on burial permit
Official Funeral Directors Reg. or License#