Morse, Frances ( Ke-n-1.4 v c F)-• .m 1/ i 1 7 - /5-- ?S/ 1-- C C v f c rurT , cN {- ,, v tr' r ,
'� NEW YORK STATE DEPARTMENT OF HEALTH 13 U v' a.:L ,
Vital Records Section Burial - Transit Permit
Name First Middle Last ' Sex
Franr c P_ Mrir4P Female
Date of Death ' Age If Veteran of U.S. Armed Forces,
Feh_ 7, 199R 99 War or Dates
Place of Death Hospital, Institution or
City, f nctltX Glens Falls Street Address Glens Falls Hospital
Manner of Death®Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined n Pending
Circumstances Investigation
14)
Am Medical Certifier Name Title
IC Dr. Robert Evans, MD
Address
Glens Falls, NY
Death Certificate Filed District Number Register Number
Mii City, Too coci®Xldi X Glens Falls 5 6 Q 1 -7
Date Cemetery or Crematory
®Burial Feb. 14, 1998 Seeley Cemetery
Address"
❑Cremation Queensbury, NY
Date Place Removed
Z ❑Removal and/or Held
,... and/or Address
Hold
Q Date Point of
N❑Transportation Shipment
d by Common Destination
Carrier
Date Cemetery Address
❑Disinterment
ii Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Sullivan, Minahan & Potter Funeral Home 01837
'< Address
407 Bay Rd. , Queensbury, NY 12804
"" Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
:U
Permission is hereby granted to dispose of the human remains de cri ed bovJ� �s in to .
IssuedEi' 2/i l7 Q &' Registrar of Vital Statistics �,, G� r-
<= Date � 9 �G"
(signature)
On
District Number 5 6 0 / Place 6 I S Pc,.\\ s) N Y 12Sd 0 I
mi
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
f-
W Date of Disposition 4/1 5/9 8 Place of Disposition Seeley Cemetery ,QueenshUrY ,NY
(address)
N Family Plot
CC (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises Rodney G. Mosher
44 --tiN
F (please print)
Signatur Title_
` a,„,,�
DOH-1555 (10/89) p. 1 of 2 VS-61
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