Usher, Frank NEW YORK STATE DEPARTMENT OF HEALTH -
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Frank Usher Male
Date of Death Age If Veteran of U.S.Armed Forces,
October 3,2006 74 War or Dates
Place of Death Hospital, Institution or
I— City of Glens Falls Glens Falls Hospital
Z City, Town or Village Street Address
ILIa Manner of Death X Natural Cause ID Accident El Homicide El Suicide El Undetermined ❑ Pending
1.11
Circumstances Investigation
u Medical Certifier Name Title
W John Stutonberg,MD
G
Address
Glens Falls,NY
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls,NY 5601 Y 8-
Burial Date Cemetery or Crematory
10/3/2006 St.Alphosus Cemetery
D Entombment Address
❑ Cremation Queensbury,NY
Date Place Removed
z ❑ Removal and/or Held
0 and/or Address
i- Hold
Date Point of
a ❑ Transportation Shipment
N by Common Destination
El Carrier
Date Cemetery Address
❑ Disinterment
Date Cemetery Address
❑ Reinterment
Permit Issued to Registration Number
Name of Funeral Home Singleton-Healy Funeral Home
Address
407 Bay Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
i,,, Remains are Shipped, If Other than Above
= Address
te
pW, Permission is hereby granted to dispose of the human remains describ ov a ' di
Date Issued /o/p 9/pt Registrar of Vital Statistics
(signature)
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance wit this permit on:
Z �`Date of Disposition � b/oil Place of Disposition 5 7: ryG PAId/VS 6/5 ---- `,1��=/vS 15'6'irt
W (address) /
LU
U) (section) (lot number) (grave number)
G Name of Sexton or Person in Charge of Premises �/9 I//9 —Ti om L) L." _j
Z (please print)
W Signature �� Title Cf'e 7,,gGf v "Pt/4 6 6'e
DOH-1555 (02/2004) (ov