Frye, Sarah q 25 g
_ L
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
i ' Name First Middle Last Sex
., . Sarah Elizabeth Frye Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/23/2018 .85 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation
Manner of Death ffie Natural Cause El Accident Homicide El Suicide ri Undetermined n Pending
Circumstances Investigation
4 Medical Certifier Name Title
Jean Flanagan MD
Address
170 Warren St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 151
❑Burial Date Cemetery or Crematory
03/26/2018 Pine View Crematory
sg,❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
❑Disinterment Date Cemetery Address
Date Cemetery Address
❑Re nterment
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
; Address
• Permission is hereby granted to dispose of the human remains described above as indicated.
zr Date Issued 03/26/2018 Registrar of Vital Statistics We6ertA Curtis(E(ectronicaaySigned)
(signature)
''1' District Number Place
° 5601 Glens Falls, New York
ti
I certifythat the remains of the decedent identified above were disposed of in accordance with this permit on:
Po
Date of Disposition 3)t1 h g Place of Disposition
(address)
(section) t number (grave number)
Name of Sexton or Person in Charge of Premises Jar
/ (pi se print)
Signature t Title MicA Pf1�
(over)
DOH-1555(02/2004)