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Frasier, Lily t i n z© NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Lilly An n Frasier Female Date of Death Age If Veteran of U.S. Armed Forces, August 12, 2017 4 War or Dates IH c of Death Hospital, Institution or iCi , own or Village Glens Falls Street Address 148 South Street WW Manner of Death❑Natural Cause Accident ® Homicide Suicide � Undetermined Pending Circumstances Investigation W Medical Certifier Name Title Michael Sikirica MD, Address 4 50 Broad Street Waterford, NY 12188 a Certificate Filed District Number Register umber � City I-own or Village � I -v 5 1--cc k k S 5601 fa ❑Burial Date Cemetery or Crematory August 15, 2017 Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed Removal and/or Held and/or Address Hold Date Point of EL- El Transportation Shipment (0. by Common Destination L3 Carrier Disinterment Date Cemetery Address :' Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above 2 Address I w a. Permission is hereb gr nted to dispose of the human remains describe a ov as ' is Date Issued or/_ 20/2 Registrar of Vital Statistics (signature) District Number 5601 Place �.a,sAi ,7 ; /f)>/ I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: uj Date of Disposition 08/15/2017 Place of Disposition Quaker Road Queensbury,NY 12804 W (address) 'G r (section) �t (lot number) (grave number) 0• Name of Sexton or Person in Charge of Pre ises L hs{ S �lc (plea a print) oil --, Signature -Lrbi._ Title ItairM'Veva- DOH-1555 (02/2004)