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Frederick, Esther E NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Esther Frederick Female Date of Death Age If Veteran of U.S.Armed Forces, 12/30/2017 91 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Queensbury Town Street Address The Stanton Nursing And Rehabilitation Centre Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title Suzanne Blood MD Address 152 Sherman Ave,Queensbury Town,New York 12801 Death Certificate Filed District Number Register Number City, Town or Village Queensbury 5657 168 ❑Burial Date Cemetery or Crematory 01/02/2018 Pine View Crematory El Entombment Address ®Cremation Queensbury, New Ythk Date Place Removed . ❑Removal • and/or Held and/or Address Hold Date Point of ❑Transportation Shipment by Common Destination Carrier El Disinterment Date Cemetery Address Reinterment Date Cemetery Address y Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom sk Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/01/2018 Registrar of Vital Statistics Confine 7CBar6er EkctronicaaySig+ud- (signature) District Number Place 5657 Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 1%Z I if Place of Disposition g.4. ...._ (address) -s (section) (lot number) (grave number) Name of Sexton or Perso in Charge of P mises .3 4"44 ( ease print) ; Signature 1 Title MOW-RI (over) DOH-1555(02/2004)