Lantz, Frank NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Frank S. Lantz Male
P'• Date of Death Age If Veteran of U.S. Armed Forces,
June 8,2017 88 War or Dates
iPlace of Death Hospital, Institution or
City, Town or Village Queensbury Street Address 17 High Pointe Drive
Manner of Death X Natural Cause ❑Accident n Homicide Suicide n Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
John Sawyer MD
{ Address
161 Carey Rd.Queensbury,NY 12804
Death Certificate Filed District Number Register Number
City, Town or Village Town of Queensbury,NY 5 L.51 I '1
❑Burial Date Cemetery or Crematory
June 9, 2017 Pine View Crematorium
❑Entombment Address
l Cremation 51 Quaker Road, Queensbury,NY 12804
Date Place Removed
z LiRemoval and/or Held
and/or Address
F- Hold
CO
O Date Point of
u) Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
�'r`. Permit Issued to Registration Number
• Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
0 53 Quaker Road, Queensbury, NY 12804
V Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
•- Permission is hereby granted to dispose of the human remains described above as indicated.
f f n ,ep.i Date Issued to 9 I ao I'1 Registrar of Vital Statistics ."�(. c. . -Lk.--
(signature)
•
District Number S G j 7 Place Q U e e h S ITV i j
I--
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 4/j1 r7 Place of Disposition ef;114-4) (r#ma{drlLk,
2 (address)
W
to
O (section) / (lot number) (grave number)
Z Name of Sexton or Person in Charge of P emises �rt Jtt,.*itt
W (pl ase print)
Signature � Title Cpt al
(over)
DOH-1555(02/2004)