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Frescatore, Rose NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial _ Transit Permit Name First Middle Last Sex Rose M. Frescatore Female Date of Death Age If Veteran of U.S. Armed Forces, March 24,2017 86 War or Dates NA 'ZPlace of Death Hospital, Institution or ' City, Town or Village Glens Falls Street Address Glens Falls Hospital lit Manner of Death Undetermined Pending X Natural Cause E Accident � (Homicide �Suicide � Circumstances Investigation_ Medical Certifier Name Title ;y. Julian Marynczak MD Address 100 Park Street,Glens Falls,NY 12801 Death Certificate Filed District Number RegisttN mber City, Town or Village Glens Falls, NY c5EW �j ❑Burial Date Cemetery or Crematory El]Entombment March 27, 2017 Pine View Crematorium Address ©Cremation 51 Quaker Road, Queensbury, NY 12804 Date Place Removed Z —Removal and/or Held 0 —and/or Address E Hold N 0 Date Point of Nn Transportation Shipment p by Common Destination Carrier (Disinterment Date Cemetery Address n Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Road, Queensbury, NY 12804 Name of Funeral Firm Making Disposition or to Whom IRemains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 3127/1 7 Registrar of Vital Statistics V' cam- -ssl- --A- (signature) District Number 5 6 Q / Place 6 (s v.s To,0 s N y I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z � j� W Date of Disposition 313o jlo Place of Disposition 'l� AIR,/ 4tmq tom. 2 (address) w cn re (section) tJJ(lot number) S- (grave number) pName of Sexton or Person in Charge of Premises ( rlhir 04/tt Z (ple se print) W l r% Signature Title (ECO At- (over) DOH-1555(02/2004)