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Frazier, Sandra NEW YORK STATE DEPARTMENT OF HEALTH r 7,ti.. l Dl it Vital Records Section Burial - Transit iermit Name First Middle Last Sex Sandra Mary Frazier Female =i Date of Death Age If Veteran of U.S. Armed Forces, December 17, 2018 63 War or Dates 3M Place of Death Hospital, Institution or City, Town or Village Moreau Street Address 1547 West River Road Manner of Death .i Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending Circumstances Investigation Medical Certifier Name Title Mark Quaresima, Address 9 Carey Road Queensbury, NY 12804 Death Certificate Filed District Number Register Number City, Town or Village Moreau (/6 i17 S 9 0 Burial Date Cemetery or Crematory December 24, 2018 Pine View Crematory ID Entombment Address g ©Cremation Quaker Road Queensbury,NY 12804 . Date I Place Removed _ ❑ Removal and/or and/or Held - Hold Address Date Point of Transportation Shipment by Common Destination Carrier Date Cemetery Address ❑ Disinterment Date Cemetery Address ❑ Reinterment Permit Issued to Registration Number Name of Funeral Home M.B. Kilmer Funeral Home-SGF 01078 Address 136 Main Street, South Glens Falls NY 12803 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address X- Permission is hereby granted to dispose of the human remains described above as indicated. Registrar of Vital Statistics Date Issued ��,�/��/ $ 9 � tel/1"(-- (signature) District Number tp 5-(e off. Place j p u/1 or. 04 d r r 4 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 12/24/2018 Place of Disposition Quaker Road Queensbury,NY 12804 (address) 0 (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premises Xfi '!` ,StAA4r (please print) W Signature 1 Title (M Dec., (over) DOH-1555 (02/2004)