Byers, Fred # 1z1
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
• Name First Middle Last Sex
• Fred Scott Byers Male
Date of Death Age If Veteran of U.S.Armed Forces,
ZR
08/15/2017 60 Years War or Dates
Place of Death Hospital, Institution or
cii City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death X❑Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
• Medical Certifier Name Title
Scott Biasetti MD
Address
100 Park St,Glens Falls,New York 12801
' Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 432
5- DBurial Date Cemetery or Crematory
08/16/2017 Pine View Crematory
a ['Entombment Address
A®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
mi
rbj Date Point of
❑Transportation Shipment
al
by Common Destination
• Carrier
• ❑Disinterment Date Cemetery Address
..h❑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
KIN Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
r Address
e
Permission is hereby granted to dispose of the human remains described above as indicated.
I, Date Issued 08/16/2017 Registrar of Vital Statistics Rg6ertACurtis 'ECectronicallySigned
(signature)
I.- District Number 5601 Place Glens Falls, New York
It I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
C
Date of Disposition girl �(� Place of Disposition ?OIL,', ' .„ra, ,V
(address)
8 (section) (lot number) (grave number)
ase
Ll Name of Sexton or Person in Charge of remisesns ,St44t�
/l� (pl print)
Signature l✓` Title /461 WA-
(over)
DOH-1555(02/2004)