Fraser, James 'Ik # ili
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
OP
Name First Middle Last Sex
', James Mackenzie Fraser Male
Date of Death Age If Veteran of U.S. Armed Forces,
02/01/2018 90 Years War or Dates 1944-1946
Place of Death Hospital, Institution or
City, Town or Village Albany Street Address St Peters Hospital
at Manner of Death FE Natural Cause El Accident 1:1Homicide 0 Suicide El Undetermined 1-1 Pending
1*3
-6- "--1 Circumstances ""-'Investigation
rg Medical Certifier Name Title
Ci Brittany Quinn NP
Address
315 S Manning Blvd,Albany,New York 12208
,,, Death Certificate Filed District Number Register Number
City, Town or Village Albany 0101 0255
LI
„...,
4k- Burial Date Cemetery or Crematory
02112/2018 Pine View Crematorium
•UEntombment
Address
Cremation Queensbury Town, New York
Date Place Removed
z 0 Removal and/or Held
and/or Address
...v Hold
Date Point of
11,Li r"-^1
Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
7.. Permit Issued to
Registration Number
i 4
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
W 68 Main Stpo Box 67,Hudson Falls,New York 12839
Name of Funeral-Firm Making Disposition or to Whom
I.:.6 Remains are Shipped, If Other than Above
i-
2 Address
Permission is hereby granted to dispose of the human remains described above as Indicated.
0:
Date Issued 02/05/2018 Registrar of Vital Statistics Dade&S giffespie iEfectroml'atry Signed)
IN (signature)
.'4 District Number 0101 Place Albany, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition il ZI hi Place of Disposition ett V-d
(address)
(section) (lot number) r (grave number)
a Name of Sexton or Person in Charge of Premisesi di tt— j
Z
UNI_ (p ase print)
Si Ei _A-
gnature Title ksittilt
(over)
DOH-1555 (02/2004) _