Shewell, Frankie NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit '�Ir
' Name First Middle Last Sex
FRANKIE ROBERT SHEWELL MALE
Date of Death Age If Veteran of U.S.Armed Forces,
! 02/04/2018 51 War or Dates
—. Place of Death Hospital, Institution
City,Town or Village City of Albany or Street Address ALBANY MEDICAL CENTER
70 Manner of Death ® Natural ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Cause Circumstances Investigation
8 Medical Certifier Name Title
in JOHN J. LEN MD
Address
64 HOWARD ST. COHOES NY 12047
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 0269
Date Cemetery or Crematory
❑ Burial 02/07/2018 PINE VIEW CREMATORIUM
❑ Entombment Address
®Cremation QUEENSBURY NY
Date Place Removed
Z Removal and/or Held
0 ❑ and/or Address
H Hold
Cl)
Date Point of
a Transportation Shipment
U) ❑ By Common El Carrier Destination
❑ Date Cemetery Address
Disinterment
Date Cemetery Address
❑
Reinterment
Permit Issued To Registration Number
Name of Funeral Home SINGLETON SULLIVAN POTTER FUNERAL HOME 01596
Address
407 BAY RD., QUEENSBURY NY 12804
Name of Funeral Firm Making Disposition or to Whom
F` Remains are Shipped, If Other than Above
Address
1
ILI Permission is hereby granted to dispose of the human remains described above as indicated.
Date 02/06/2018 , t-z L- '
Issued Registrar of Vital Statistics
(signature)
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F' Date of Disposition lI 7112 Place of Disposition 37w 1J'.I 4"'76w""�-
W (address)
2
w
co
c[ (section) (lot number (grave number)
0
Z Name of Sexton or Person in Charge of Premises (iatia '^%•t
w (please print)
Signature ii J Title ( MATD1L
(over)
DOH-1555 (02/2004)