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Fritze, June I NEW YORK STATE Df.PARTMENT OF HEALTH Vital Records Section" Burial - Transit Permit Name First Middle Last Sex June C. Fritze Female Date of Death Age If Veteran of U.S. Armed Forces, Jan 05 2016 84 yrs. War or Dates no } Place of heath ' Hospital, Institution or Z CitItiy, Town or Village Glens Falls Street Address Glens Falls Hospital a Manner of Death©Natural Cause 0 Accident 0 Homicide 0 Suicide 0 Undetermined 0 Pending tki Circumstances Investigation til Medical Certifier Name Title Address Death Certificate Filed District Number Registermber City, Town or Village Glens Falls, NY. 5601 gi 0Burial Date Cemetery or Crematory Jan.0 , 2016 PineView crematorium `: ;0 Entombment Address ©Cremation Ouaker Rd. , Oueensbury, NY. 12804 Date Place Removed Z Removal and/or Held ❑and/or Address t Hold Date Point of tit Transportation Shipment is by Common Destination az Carrier Disinterment Date Cemetery Address 0 Reinterment Date Cemetery Address iiig Permit Issued to O Mason Funeral Home Reg� ration Number Name of Funeral Home liliE Address 18 George St. , P.O. Box 277, Fort Ann, NY. 12827 Name of Funeral Firm Making Disposition or to Whom 14 Remains are Shipped, If Other than Above 2 Address Cr Il U- Permission is hereby granted to dispose of the human remains described abov as iodic ted. >" Date Issued Jan. 05, 2 0Rtjistrar of Vital Statistics 4' d ,i signature) District Number 5601 Place City of Glens Falls, NY. /-ZfJ f ZI certify that the remains of the decedent identified above were disposed of in accordance with this permit on: >..;.: Iti Date of Disposition /-40-/6O Place of Disposition P7')_ Ur eul 'rt?f-r7e 47 , (address) Ili to cc (section) pot number) (grave number) Name of Sexton Person 'n Charge of Premises -ire- J%�rt ..-�2,,-.et (please print) Signature Title Grw-m4 (over) DOH-1555 (02/2004)