Pravada Jr., Frank t- - 1 1 # 3S6)
NEW YORK STATE DEPARTMENT OF HEALTH ,.
Vital Records Section • Burial _ Transit Permit
Name First Middle Last Sex
Frank Pravda Jr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
05 / 01 / 2017 89 War or Dates
}- Place of Death Hospital, Institution or
Z City, Town or Village Wilton Street Address 150 Ingersol Road
Ili
0 Manner of Death Natural Cause E Accident El Homicide D Suicide 7Undetermined �Pending
Circumstances Investigation
111 Medical Certifier Name Title
Nancy Barraclough MD
Address
3050 NY-50, Saratoga Springs, NY 12866
Death Certificate Filed District Number Register Nu er
City,Town or Village Wilton 'l ��q 01
DBurial Date Cemetery or Crematory
05 / 04 / 2017 Pine View Crematory
jEntombment Address
iiii EsCremation Queensbury, NY
Date Place Removed
❑Removal and/or Held
and/or Address
t:: Hold
OP
IV Date Point of
Q Tr03 ansportation Shipment
by Common Destination
Carrier
❑Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
iiils
« Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
Mi 402 Maple Ave., Saratoga Sp. , NY 12866
`< Name of Funeral Firm Making Disposition or to Whom
.,. Remains are Shipped, If Other than Above
Address
CC
w
Permission is he eb granted to dispose of the human remains described abo ass indicated.
Date Issued 5 4 11 Registrar of Vital Statistics C (,tXci,(.,0-1.A......,
(signature)
Mi District Number it.I '3(pq Place Wilton , New York
IF- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
•
2 h 11 ''
in Date of Disposition VS- Place of Disposition �,�e A_# ei w G f,....
ZE (address)
tit
0
IC (section) /, (lot number) c (grave number)
Name of Sexton or Person in Charge of Premises ( � J VIA lit
(p141ase print) •
LE Signature V( Title (Rim
(over)
DOH-1555 (02/2004)