Loading...
Trepanier, Francis NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex '%f' Francis J. Trepanier Male i Date of Death Age If Veteran of U.S. Armed Forces, Y December 2, 2016 86 War or Dates Korean War Place of Death Hospital, Institution or City, Town or Village Town of Queensbury Street Address 37 Surrey Field Drive Queensbury, NY Manner of Death I Xir—I Natural Cause n Accident n Homicide n Suicide 1-1 Undetermined n Pending ta Circumstances Investigation :: Medical Certifier Name Title Anthony Petrucca MD `'''' = Address 3 Irongate Center,Glens Falls,NY 12801 Death Certificate Filed District Number Register Number City, Town or Village Town of Queensbury, NY S Ln 5 11 c el ❑Burial Date Cemetery or Crematory December 2, 2016 Pine View Crematorium ❑Entombment Address ©Cremation 51 Quaker Road, Queensbury, NY 12804 Date Place Removed ZO n Removal and/or Held and/or Address H Hold CO O Date Point of NU Transportation Shipment p by Common Destination Carrier El Disinterment Date Cemetery Address n Renterment Date Cemetery Address ,' Permit Issued to Registration Number "'' Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 r Address 407 Bay Road, Queensbury, NY 12804 a Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. f IiiDate Issued t a- -an 1(' Registrar of Vital Statistics _ �c-Q�=e.Li (signature) r; District Number 545 '7 Place Q v t c n c bV1 0 JJ I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: cu Date of Disposition 1zfg ii6 Place of Disposition r,�J�.v✓ e afro-' (address) W U) CL (section) /s (lot number) r (grave number) pName of Sexton or Person in Charge of Premises lAor^e r 3 wile Z (pl relic. print) W Signature i�'' -4-- Title try Mai (over) DOH-1555(02/2004)