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Boisclair, Norman Jean NEW YORKSTATE DEPARTMENT OF HEALTH (CO) Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Norman Jean Boisdair Male Date of Death Age If Veteran of U.S.Armed Forces, 01/16/2024 77 Years War or Dates 1965-1969 Place of Death Hospital,Institution or • City,Town or Village Glens Falls Street Address Glens Falls Hospital 'p Manner of Death ®Natural Cause Accident Homicide Suicide ❑Undetermined Pending Circumstances Investigation W Medical Certifier Name Title O Melody Long PA Address 100 Park Street,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number t",Town or Village 5601 35 Burial Date Cemetery,Crematory or Facility Name 01/20/2024 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation goRemoval Date Place Removed and/or and/or Held Hold Address O O. Date Point of (I) Transportation a by Common Shipment Carrier Destination ODisinterment Date Cemetery Address OReinterment 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 -. Remains are Shipped,If Other than Above 2 Address W a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/19/2024 Registrar of Vital Statistics 9Kegan Wolin(ECectronicalySigned) (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 72 f 2q Place of Disposition Fgv6U$E,,J C040 rOAr (address) W (section) /A1L/lot number/� /gravenumber/ Name of Sexton or Person in Charge of Premises / a J ( ease print) W Signature Title 7NQ DOH-1555(07/18)p 1 of 2 ._ 1 " a .,r ;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#