Frost, George I \ .41 tf
NEW YORK STATE DEPARTMENT OFAEALTH
Vital Records Section 40
Burial - Transit Permit
71 Name First \ Middle Last Sex
Lt George Charles Frost Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/30/2017 89 Years War or Dates 1952-1954
Place of Death Hospital, Institution or
• City, Town or Village Queensbury Town Street Address The Stanton Nursing And Rehabilitation Centre
0 Manner of Death o Natural Cause Accident Homicide 0 Suicide Undetermined Pending
Circumstances Investigation
ui Medical Certifier Name Title 9Roslyn Socolof MD
Y
Address
152 Sherman Ave,Queensbury Town,New York 12801
Death Certificate Filed District Number Register Number
• City, Town or Village Queensbury 5657 135
-'El Burial Date Cemetery or Crematory
10/31/2017 Pine View Crematory
• ❑Entombment
Address
®Cremation Queensbury Town, New York
Date Place Removed
Removal and/or Held
g and/or Address
MHold
0 Date Point of
to ❑Transportation Shipment
tz by Common Destination
Carrier
ri
❑Disinterment
Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
▪ Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078
▪ Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
te
tPermission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/31/2017 Registrar of Vital Statistics carotne'(Barber ECectronicaaySigned"
(signature)
▪ District Number 5657 Place Queensbury, New York
certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 1/ /i I(7 Place of Disposition {'„,A).,,,r, 4.-07t0(t_..
(address)
iii
i (section) ,// (lot number) (grave number)
QName of Sexton or Person in Charge of Pr mises br.= qt.. 5 a"--let
Z (plelase print)
Signature Title f REI#tt
(over)
DOH-1555 (02/2004)