Frielinghaus, Joyce NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Joyce P. Frielinghaus Female
Date of Death Age If Veteran of U.S. Armed Forces,
//aOa 7 /,rS. War or Dates
ZPlace of Death Hospital, InstitutiorIndian River Rehab & Health Care
City, Town or Village Granville Street Addresstil Center. Inc.
ci Manner of Death U Natural Cause Accident n Homicide Suicide Undetermined Pending
Ida' Circumstances Investigation
Medical Certifier Name Title
s Jennifer Hayes,MD
Address
Granville,NY
-0e Death Certificate Filed District Number � Register umber
City, Town or Village Granville,NY
❑Burial Date Cemetery or Crematory
November 9, 2011 1 Pine View Crematory
❑Entombment Address
,RiCremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
9. and/or Address
H Hold
N
0 Date Point of
N n Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
H Renterment Date Cemetery Address
v: Permit Issued to Registration Number
v. 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
ty:+ Remains are Shipped, If Other than Above
5 Address
tiS
Err° Permission is hereby ranted to dispose of the human remai s desc ' d a ve as indicated.
Date Issued `/ c� /� Registrar of Vital Statistics Wt.
(signature)
District Number 5 77 5 Place Granville,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
W Date of Disposition Nov ` 1 Zqt Place of Disposition e,y,uu� Lft ' orivf.
2 (address)
W
CO
re (section) / (lot number) (grave number)
pName of Sexton or Per on in Charg of Premises [` Lr,5t r ennit(-
ZZ-1 (please print))
W Signature Title CQI~M14-42-
(over)
DOH-1555(02/2004)