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Norton, Richard Lev NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Richard Norton Male Date of Death Age If Veteran of U.S.Armed Forces, 11/12/2023 76 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Schuylerville Village Street Address 21 Spring Street, Schuylerville Village,New York 12871 'IJ p Manner of Death Natural Cause Accident ❑Homicide []Suicide []Undetermined ❑Pending C.) ' 'Circumstances Investigation W Medical Certifier Name Title O Paul Byron MD Address 719 719 County Rt 60,Greenwich Town,New York 12834 Death Certificate Filed Village Of Schuylerville District Number Register Number City,Town or Village 4525 004 Burial Date Cemetery,Crematory or Facility Name 11/16/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held F N Hold Address 0 111 Date Point of U)[]Transportation p by Common Shipment Carrier Destination o Disinterment Date Cemetery Address []Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above Address Q W O Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/16/2023 Registrar of Vital Statistics Helene Patterson(Electronically Signed) (signature) District Number 4525 Place Village Of Schuylerville I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Ir W Date of Disposition )((i11 j3 Place of Disposition 'T.lEEJ C mil iiJn� 2 (address) W N (section) (lot number) <- (grave number) /11.41L- — OAGName of Sexton or Person in Charge of Pr isesA4�ase print) LU Signature Title ` v 4 Ta DOH-1555(07/18)p t 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#