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Frazer, MacPherson . /I g 53 NEW YORK STATE DEPARTMENT OF I1LTH Vital Records Section Burial - Transit Permit Name First Middle Last I Sex MacPherson ('k1 p G,I . Beldon Frazier frct•2c - Male Date of Death Age . •If Veteran of U.S.Armed Forces, 6/22/2016 186 War or Dates - Place of Death Hospital. Institution or City.Town or Village Argyle $ Street Address 4713 SR 40, Argyle,NY 12809 Manner of Death Natural Cause 0 Accident []Homicide ❑Suicide ❑Undetermined ©Pending Circumstances Invest gation Medical Certifier Name Title C! Michael Layden Address 1 Heartway Queensbury,New York 12804 Death Certificate Filed District Number ] Register Number City.Town or Village Fort Edward .S 7.56 1 a b ❑Burial Date Cemetery or Crematory 6/23/2016 ❑Entombment-Address [Cremation Date Place Removed ri Removal and/or Held and/or Hold Address Date Point of 2 0 Transportation I Shipment O by Common ! Destination Carrier Disinterment Date Cemetery Address Reinterment r Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M.B. Kilmer Funeral Home-Fort Edward 101079 Address 82 Broadway, Fort Edward,NY 12828 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped. If Other than Above Z Address CC W, 12' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued (o 3 )201 b Registrar of Vital Statistics T,4.4.si/N r, �464,t .� District Number 5 7s,, Place .�,5 Ni 4 N' J I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: it Date of Disposition C./NUL Place of Disposition g tLLs. 44112, •-•0' (addross) (sstroan) //I (Jor n ) (grave numbor) 1 Name of Sexton or Person in Charge of Premises ` ti " `^e4 z Plesse Prot) IW Signature a Title CrWherri n (over) DOH=i 555(02/2004)