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LaRose, Norma Dorothea �� - 4g ba NEW YORK STATE DEPARTMENT OF HEALTH t BurialTransit Permit Bureau of Vital Records Name First Middle Last Sex Norma Dorothea La Rose Female Date of Death Age If Veteran of U.S.Armed Forces, 10/23/2023 98 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 a Natural Cause EAccident 0 Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title 0 Courtney Diamond NP Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 493 E Burial Date Cemetery,Crematory or Facility Name 10/26/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York [Donation ZZ❑Removal Date Place Removed and/or and/or Held _ H Hold Address N w 0 0. Date Point of (/)ETransportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address EiReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above 2 Address II W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/25/2023 Registrar of Vital Statistics Megan Nofin(E(ectronicaCCy Signed) (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: Z W Date of Disposition /Q-�73 Place of Disposition , e eeq) rd 2 (ad ress/ W CC N (section) (lot number) (grave number) SName of Sexton or Person in Charge of Premi a �/V/1/drf J L Z (please print/ IllSi nature o g � Title 0(21.A.-424.1— DOH-1555(o7/18)p t of 2 ^A 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# f