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Thompson, Frank NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Frank E. Thompson male Date of Death Age If Veteran of U.S. Armed Forces, February 7, 1995 War or Dates t. Place of Death Hospital, Institution or City, Town or Village City of Glens Falls Street Address Glens Falls Hospital tti a Manner of Death©Natural Cause 0 Accident 1=I Homicide CI Suicide Undetermined 0 Pending W Circumstances investigation Medical Certifier Name Title O David Thompson MD Address 88 Broad Street, Glens Falls, New York 12801 Death Certificate Filed District Number Register Number City, Town or Village City of Glens Falls `., (,/ _ • Date TCemetery or Crematory ❑Burial Address ❑Cremation Date Place Removed UFA Removal February 10, 1995 and/or Held Pine View Cemetery Vault •— and/or Address Hold Queensbury, New York Q Date I Point of 0 Transportation Shipment ifl by Common Destination Carrier Disinterment Date Cemetery Address El Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan and Denny Funeral Service, Inc. 01583 Address 53 Quaker Road, Queensbury, New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above 4 Address MA A. aiii Permission is hereby granted to dispose of the human remains described above as in 'cated. `` Date Issued o2 9`Lj j 4067,45YRegistrar of Vital Statistics g' (signature) / << District Number ,j lv 0 / Place �J/-P� p /_ /// /U/ I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: f.- Cor. Luzerne Rd. & Pine St. W Date of Disposition 05/13/95 Place of Disposition St. Alphonsus Cemetery, Queensbury, NY 12804 2 (address) U) 3 grave section, Row P, Lot 21 So. Half, Gr. # 3 CC (section) (lot number) (grave number) 0 Name of Sexton or Person in Ch e of Premises Rev. Robert W. Powhida Z (please J print) W Signature �./ D l/V� Title Pastor DOH-1555 (10/89) p. 1 of 2 VS-61