Synder, Sr. Frank NEW YORK STATE DEPARTMENT OF HEALTH 5S6
Vital Records Section it Burial - Transit Permit
Name First Middle Last Sex
Frank Synder, Sr. Male
• Date of Death Age If Veteran of U.S. Armed Forc ‘,
November 4, 2011 71 War or Dates e.)4 •
Place of Death Hospital, Institution or
City, Town or Villa Glens Falls Street Address Glens Falls Hospital
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• Manner of Death V Natural Cause n Accident n Homicide Suicide Undetermined Pending
W Circumstances Investigation
Medical Certifier Name Title
;gs MD-
Address
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Death Certificate Filed District Numbe5601 Register m er
City, Town or Village Glens Falls
❑Burial Date Cemetery or Crematory
November 7,2011 Pine View Crematorium
❑Entombment Address
❑x Cremation 21 Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
N
O Date Point of
85 I 1 Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
`: Permit Issued to Registration Number
• Name of Funeral Home Singleton-Healy Funeral Home 01596
; Address
407 Bay Road, Queensbury, NY 12804
:: Name of Funeral Firm Making Disposition or to Whom
;i : Remains are Shipped, If Other than Above
° Address
re
us
Permission is hereby granted to dispose of the human rains scribed above as indi ate
Date Issued Registrar of Vital Statistics /�.e�� ��� U'22--(.,
(signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition NuU opt ZA(i Place of Disposition 2MJuJ Ccvomturbo_
w (address)
W
CO
re (section) . (lot numb (grave number)
pp Name of Sexton or P r on in Charge of Premises 4,11•4r- Jth.r(t
Z 1 (please print)
W
Signature /4.jL_ Title rim Mlti aL
(over)
DOH-1555(02/2004)