Fragnoli, Anthony NEW YORK STATE DEPARTMENT OF HEAL14-1 / `0
Vital Records Section Burial - Transit Permit
„<; Name First Middle Last Sex
lit Anthony Phillip Fragnoli Male
IN Date of Death Age If Veteran of U.S.Armed Forces,
11/19/2014 83 years War or Dates
a Place of Death Hospital,Institution or
49 Nlifiaown or ARM Glenville Street Address 43 Pinpwnnd Drivv
G . Manner of Death[ Natural Cause [Accident []Homicide 0 Suicide Q Undetermined Pending
la Circumstances Investigation
w Medical Certifier Name Title
P Max Crossman Md
Address
fg 65 Poultney St.Whitehall,Ny 121887 .
iiil Death Certificate Filed District Number Register Number
eli mown or X Glenville 4651 111
El Burial Date • - Cemetery or Crematory .
'' 11/25/2014 Pineview Crematory
.ig,,❑ ntombment Address
hremation Queensbury, N Y
,, Date Place Removed
io-i❑Removal and/or Held
and/or Address
k"` Hold
13 Date Point of
D Transportation Shipment
C by Common Destination
Carrier
ill[]Disinterment
Date ` Cemetery Address
Date Cemetery Address _
Si Q Reinterment
>_ Permit issued to Registration Number
r Name of Funeral Home Jillson Funeral Home, Inc. 00897
;.'. Address .
mi 46 Williams St.,Whitehall, N.Y. 12887 •
«`= Name of Funeral Firm Making Disposition or to Whom
1 Remains are Shipped, If Other than Above
2 Address
filV
Permission is hereby granted to dispose of the human remains described above as indicated.
i Date Issued Registrar of Vital Statistics 2 ,��,..:� 11/20/2014 � �. signaturpazy..._.
District Number 4651 Place Glenville
i"' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2
2 Date of Disposition 11 f ZOO i Place of Disposition -rh=u rir cot,,, -
2 (address)
Iii
0
l (section) (lot number) (grave number)
ti Name of Sexton or Persola an in Char.• of Premises ' r f' gs,'IV
( tom)
Signature J Title C ilri3v4
. (over)
DOH-1555 (02/2004)