Snyder, Frederick NEW YORK STATE DEPARTMENT OF HEALTH" i 7/ i
Vital Records Section Burial - Transit Permit
`a Name First Middle Last Sex
Frederick J. Snyder Male
, Date of Death Age If Veteran of U.S. Armed Forces,
'f January 19, 2017 44 War or Dates
?% Place of Death Hospital, Institution or
City, Town or Village Granville Street Address Indian River Nursing Home
Manner of Deathu_ki Natural Cause El Accident Homicide n Suicide Undetermined n Pending
Circumstances Investigation
Medical Certifier Name Title
Thomas Kandora Dr.
Address
WA 2 Broad Street�; ; ,Glens Falls,NY 12801
,?. Death Certificate Filed District Number Registe umber
i
Cty, Town or Village Granville
❑Burial Date Cemetery or Crematory
January 23, 2017 Pine View Crematorium
IIIEntombment Address
❑x Cremation 51 Quaker Road, Queensbury, NY 12804
Date Place Removed
ZZ IT❑Removal and/or Held
and/or Address
H Hold
Cl)
O Date Point of
N ❑Transportation Shipment
'p by Common Destination
Carrier
Disinterment Date Cemetery Address
Ej
Reinterment Date Cemetery Address
;;;tea Permit Issued to Registration Number
f.. Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
a Address
l> 407 Bay Road, Queensbury, NY 12804
:' Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is he eby granted to dispose of the human remai descs = . •ove indicated.
wf<>.> Date Issued aaio v Registrar of Vital Statistics !/-/
;; i (signature)
<'",, District Number cf7A5—Place 6I ' 'wep y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z p
W Date of Disposition J/L31,1 Place of Disposition V! -J 1:41V df'iti.-.
W (address)
N
Ce (section) r//(lot number) (grave number)
pName of Sexton or Person in Charge of Premiss `hrir Stn1lit
Z (pl ase print)
ILIlit
Signature Title ( t
(over)
DOH-1555(02/2004)