Fredette, Maurice :4 '77
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
a Name First Middle Last Sex
4. Maurice Sherwin Fredette Mal
Date of Death Age - If Veteran of U.S. Armed Forces,
10/26/2018 85 Years War or Dates 953-1955
—
Place of Death Hospital, Institution or
inCity,
FE ❑Town or Village Glens Fags Street Address Glens Falls Hospital
Manner of Death Natural Cause ❑Accident 0 Homicide 0 Suicide Undetermined ri❑Pending
Circumstances Investigation
k. Medical Certifier Name Title
1 Marvin Davidowitz MD
1 Address
100 Park St,Glens Falls.New York 12801
- Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls - ` 5601 504
[]Burial Date Cemetery or Crematory
10/29/2018 Pine View Crematorium—
❑Entombment Address -
,: Cremation Queensbury Town. New York J�
Date Place Re oved
El Removal and/or He
and/or Address .
Hold
Date Point of
tl? L jr-1Transportation Shipment
by Commonio Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
t,
Permit issued to Registration Number
, Name of Funeral Home Carleton Funeral Home Inc 00281
, Address
68 Main Stpo Box 67,Hudson Falls,New York 12839
;,1 Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
M
C't: Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/29/2018 Registrar of Vital Statistics -Robert.A Curtis(E4ctrona`c.at(ySgne ))
(signature)
District Number 5601 Place Glens Falls. New York
6. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ill Date of Disposition /D 13D lif Place of Disposition �? � ,,, ( prt,,.,
3' (address)
N
CC (section) /h (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises l r> kr () eA4illt
J� please print)
4 Signature iv Title ( 14Z.
(over)
DOH-1555 (02/2004)