Mallison, Frank NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Frank Robert Mallison Male
Date of Death Age If Veteran of U.S. Armed Forces,
12/05/2017 74 years War or Dates 1950-53
; - Place of Death Hospital, Institution or
Ci , Tq Glens Falls Street Address Park St Glens Falls. N Y
qManner of Death r,Natural Cause ❑Accident ElHomicide ❑Suicide ❑Undetermined ❑Pending
W. Circumstances Investigation
ila
ikt Medical Certifier Name Title
gi Gerald Abess M D
Address
3 Irongate Plaza Glens Falls, N Y 12801
iI th Certificate Filed District Number Register Number
City, cX9007 ( Glens Falls 5601 632
>?<' VIVO(
Date Cemetery or Crematory
❑Entombment 12/13/2017 Pine View Cematory
Address
< ;[Cremation Queensbury, Ny
Date Place Removed
❑Removal and/or Held
TT and/or Address
0 Hold
IA
0 Date Point of
to Li Transportation Shipment
C by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home 01078
Address
82 Broadway Fort Edward, Ny
liF Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
a Address
CC
lI
P` Permission is hereby granted to dispose of the human remains desc ibed above as i 'cated.
Date Issued _ 12/08/2017 Registrar of Vital Statistics
(signs ure)
District Number 5601 Place Glens Falls
certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Disposition111 Place of Pill i/i7..r,1 r-6-1„-ski(address
Date of Disposition ►2�i�1/17
ILL
CC (section) //(lot number) (grave number)
CIName of Sexton ers in Charge of Premises i -ti2,,,- C.�.-✓✓sue ��
2 (please print)
Signature Title C--,re---"e4/'
(over)
DOH-1555 (02/2004)