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Fredette, Dayton it NEW YORK STATE DEPARTMENT OF HEALTH + 3'` '10 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Dayton W. Fredette Male Date of Death Age If Veteran of U.S.Armed Forces, Yes WW II F. March 6, 2016 89 War or Dates Place of Death Hospital, Institution or W City,Town,or Village Argyle Street Address Washington COunty Nursing and Rehab. Cre G Manner of Death ©Natural Cause El Accident 0 Homicide 0 Suicide 0 Undetermined n Pending W Circumstances Investigation U Medical Certifier Name Title W Dr. Edit Masaba, M.D. Dr. 0 Address 200 Main Street, Greenwich, NY 12834 Death Certificate Filed District Number Register Number City,Town or Village Argyle ❑Burial Date Cemetery or Crematory March iv 2016 Pineview Crematorium ❑Entombment Address Q Cremation Quaker Road Queensbury, NY 12804 Date Place Removed 0 n Removal and/or Held - and/or Address I' Hold - 14 Date Point of a0 Transportation Shipment L by Common Destination Carrier Date Cemetery Address a ❑Disinterment Renterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Jillson Funeral Home, Inc. 00885 Address 46 Williams Street, Whitehall, New York 12887 ~ Name of Funeral Firm Making Disposition or to Whom x Remains are Shipped, If Other than Above W Address Cl. Permission is hereby granted to dispose of the huma ins described above as indica ed. Date Issued '3\3 o\ Registrar of Vital Statistics ins \c\1< v- V , (signature) District Number 51 c3 G Place Argyle,New York F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition 03/10/2016 Place of Disposition Pineview Crematorium 2 (address) UI 40 0 (section) (lot number)(' (grave number) O Name of Sexton or Person in Charge of Premises 4006'`'' J tAtVit Z � (please print) SignatureIll a „ . Title �fLi'Hb'r , (over) DOH-1555 (02/2004)