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Fraser, Scott MacKenzie IZ3 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Scott MacKenzie Fraser Male Date of Death Age If Veteran of U.S.Armed Forces, 02/03/2020 66 Years War or Dates ZPlace of Death Hospital,Institution or pCity,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare Mannerof Death ©Natural Cause E1 Accident Homicide Suicide Undetermined Pending W U Circumstances Investigation WW Medical Certifier Name Title Edit Masaba MD Address 4573 State Route 40,Argyle Town,New York 12809 Death Certificate Filed District Number Register Number City,Town or Village Argyle 5750 6 Burial Date Cemetery,Crematory or Facility Name 02/05/2020 Pine View Crematorium Entombment Address Rel Cremation Queensbury Town,New York Donation 0 ❑Removal Date Place Removed H and/or and/or Held N Hold Address O d Date Poi nt of N Transportation p by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition orto Whom Remains are Shipped,If Other than Above Address W 9" Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/04/2020 Registrar of Vital Statistics SheCCey 912ckemon(ECectronicady Signed) (signature) District Number 5750 Place Argyle, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 2/4110 Place of Disposition r d 2 (address) W N Q (sedion) (lotnumber) (grave number) 0 Name of Sexton or Person in Charge of Premises Z (ple a print) W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 131,31,8 Receipt Human remains of delivered on , 20_ Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#