Frye, Gordon 1 IR
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NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
1!:ig Name First Middle Last Sex
Gordon W. Frye Male
Date of Death Age If Veteran of U.S.Armed Forces,
06 / 11 / 2016 81 War or Dates
Place of Death Hospital, Institution or
lc City,Town or Village Saratoga Springs Street Address Wesley Health Care Center
aManner of Death®Natural Cause El Accident 0 Homicide Suicide 17 Undetermined ri Pending
Ai Circumstances Investigation
LI
Al Medical Certifier Name Title
Rich D. Teetz MD
Address
ilig 1134 NY-29, Greenwich, NY 12834
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs i j b( ?_")
[ Burial Date f / �!f/ �� Cemetery or Crematory
7 Pine View Crematory
®Entombment Address
? Cremation Queensbury, NY
Date Place Removed
1❑Removal and/or Held
and/or Address
Hold
0 Date Point of
Si0 Transportation Shipment
ES by Common Destination
Carrier
.0 Disinterment Date Cemetery Address
;iii. Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care, Inc 00364
cl Address
402 Maple Ave., Saratoga Springs, NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is her by g anted to dispose of the human remain -be abo icated.
Date Issued Jl Registrar of Vital Statistics
E i (signature)
11 District Number 4 s b 1 Place Saratoga Springs , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
114 Date of Disposition CO I/Flab Place of Disposition 120411,✓ [ ,, •*--
x (address)
M.
tr (section) .(lot umb�` (grave number)
0 Name of Sexton or Person in Charge f Premises I ► J v"4�
( ease print).
Signature at
(/` Title Cgg,11 6 Fr
(over)
DOH-1555 (02/2004)