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Frazier, Karen 5ry NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section E Burial - Transit Permit — Name First Middle Last Sex Karen Frazier Female Date of Death Age If Veteran of U.S. Armed Forces, July 27, 2017 58 War or Dates Place of Death _. Hospital, Institution or w City, Town or Village Street Address © Manner of Death X❑Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ri 1-1 Pending CircumstancesInvestigation Medical Certifier Name Title Michael Sikirica , Dr. Address 50 Broad Street Ste 1 Waterford, NY 12188 Death Certificate Filed District Nun ter Register Number City, Town or Village .5j" 4�1( 7 ❑Burial Date Cemetery or Crematory August 1, 2017 Pine View Crematory ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed � ❑ Removal and/or Held ` and/or Address Hold 5' Date Point of g. ❑Transportation Shipment by Common Destination O Carrier Date Cemetery Address ❑ Disinterment Date Cemetery Address ❑ Reinterment Permit Issued to Registration Number Name of Funeral Home M.B. Kilmer Funeral Home-SGF 01078 Address 136 Main Street, South Glens Falls NY 12803 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address CC ill a. ,. Permission is hereby granted to dispose of the human re ains describe a ve as indicated. Date Issued 7 g / 'O/7 Registrar of Vital Statistics "�,..,i .&-i (signature) District Number � 9 Place G�/�a. � / �'7 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 08/01/2017 Place of Disposition Quaker Road Quee sbury,NY 12804 (address) w' C (section) (lot number) (grave number) i Name of Sexton o P rso in Charge of Premises 3 uLi e-., ‘41.-04 -G (please print) W Signature Title e.--r (over) DOH-1555 (02/2004)