Frasier, Julius '313
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First/ . Middle Last Sex Iv
Ju I us •/16sr Frasicr`
x
Date of Death Age If Veteran of U.S.Armed Forces. i
ar- De'z /Li/ 2017 (07 War or Dates
>- Place of Hospital, Institution or t �
City, Town or Village Queensbt.0y Street Address /DSZ h/�r� r'/dvnf�t i., oo
Manner of Death l'a Natural Cause Accident Homicide Suicide Undetermined fl Pending
�,4� Circumstances Investigation
Medical Certifier Name Title
0 John R(1tg8 e Hi)
Address
374 7 Ma, crkee / W refisbtif •ic e)V /2Yei-
it Death Certificate Filed / ct triter �/ Rr Number
City,Town or Village (M e e/Is-k r �,
Date etery or Crematgry / t
Burial lab 7 I-c V e eM aiel
Address J1 , / (/�
{Cremation Qb0 Rom� ( tee.,'1srWiz,, /V� Vark_ /Z-�
g Date Place Removed
0❑Removal and/or Held
t•• and/or Address
aHold
0 Date i Point of
ND Transportation j Shipment
a by Common Destination
Carrier
0 Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
t- Permit Issued to Registration Number
. Name of Funeral Home er &perclme- Q(13Q
Address it/ L Name of Funeral Firm Making Disposition or to Whom
Gtfa y�e t . / b u�p &i.-ry r jue . ) Jty-)L )a,7(Y
Remains are Shipped, If Other than Above
I
Address
Permission is hereby granted to dispose of the human r ai s d ve i
r, Date Issued 4—i a--i `1 Registrar of Vital Statistics �vt Gt
(sig ture)
ii District Number "c�,`il Place /1 t;1rnA 4'(.1,A-
E
I. certify that the remains of the decedent identified were disposed of in.a • d- - with this permit on:
i
X Date of Disposition /7 Place of Disposition Pi�7 Q-Vi�C.c/�� - y
(address)
iii
Sl}
E' (section) \ 1 , (lot nujpber) i (grave number)
QName of Sexton or P in Charge of Premises ->' rQ /12
g (please print)
Signature Title Ca..ma.ref
'•'•L
(over)
DOH-1555 (9/98)