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Waite, Frances 101281201E 11:01 518377344E I LIGHTS FUNERAL HOME PAGE 02/02 - NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit k, Name First Middle Last Sex Frances J., nis 18/. - ;' Date of Death Age If Veteran of U.S. Armed Forces, .f'; 10/77/7016 71 years _ War or Datesty ': Place of Death Hospital, Institution or City •e Street Address 1 ,..,+ - y: chenectady Ellis Manner o se- % Natural Cause ©Accident El Homicide U Suicide fl Undetermined []Pending Circumstances Investigation lrjMedical Certifier Name Title riJohn.Sun-- 4 Address 1101 Nott St, Schenectady, N Y 12308 Death Certificate Filed District Number Register Number u City A.oAu. , :•e .-.- _• ,.6 bate •, `w ❑Bur..I Cemetery or Crematory ;nos 'Y��' 7 t1ressIR t raf19 R , I-ntombment Add Yw GrsrrtatiariE,m — '''' %Cremation Date Place Removed ❑Removal and/or Held and/or Address Hold Date - — Point of rii pi Transportation Shipment ci by Common Destination $k> Carrier ' Date Cemetery Address ,'❑Disinterment {`' Date `u 0 Reinterment Cemetery Address Permit Issued to Registration Number . Name of Funeral HomiRe_ sn& Denny Funeral Service 0144 Address "g 53 Quaker R&Queensbury N Y 12804 $ Name of Funeral Firm Making Disposition or to Whom - ;; Remains are Shipped, If Other than Above 13 Address Y.' Permission is hereby granted to dispose of the human remai eicrib d abo as i ted. • Date Issued 10/28/2016 Registrar of Vital Statistics s L/D4--- (signattiro) , District Number Place } , rhenectedy I certify that the remains of the decedent identified above were.disposed of in accordance with this permit on: Date of Disposition ///I,/). Place of Disposition et�a�, loi (address) 64 tt (section) /.(lot number)c (grave number) Name of Sexton or Person in Charge o fPremises _`,s ,r. er Z 41 Ll (Pe pr1�Signature _ - Title test M_ (over) DOI-I-1555 (02/2004)