Hall, Norman Lee NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records -'"'^=-_,„-- Burial - Transit Permit
Name First Middle Last Sex
Norman Lee Hall Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/18/2023 83 Years War or Dates Army
Place of Death Hospital,Institution or
naZ City,Town or Village Glens Falls Street Address 19 Cunningham Avenue, Glens Falls, New York 12801
Manner of Death Natural Cause EAccident El Homicide 0Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Joseph Mihindukulasuriya MD
Address
20 Murray Street,Glens Falls,New York 12801
Death Certificate Filed CityyOf Glens Falls District Number Register Number
, City,Town or Village v 5601 39
Burial Date Cemetery,Crematory or Facility Name
01/21/2023 Pine View Crematory
_Entombment Address
j, Cremation Queensbury Town,New York
Donation
g2
El Removal Date Place Removed
and/or and/or Held
Hold Address
tb
i0
Transportation Date Point of
by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Date CemeteryAddress
, Reinterment
'-, 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
Remains are Shipped,If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/20/2023 Registrar of Vital Statistics Wegan Wolin(ECectronica1TySigned)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
auDate of Disposition I'Z/-e o�j Place of Disposition }�',i\i'c? kJ;Cub: C r it,k
(address)
(section) (lot number) (grave number)
Name of Sexton or Person in Charge If Pre is lei)in p ✓I> wile;coS
j (please print/
" Signature 71I✓ jd /U Title V cJ`t' "�
DOH-1555(07/18)p 1 of 2
- j sTa'. 3
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#