Frank, Robert NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Robert C. Frank Male
_` ' Date of Death Age If Veteran of U.S. Armed Forces,
nF June 9,2016 86 War or Dates
Place of Death Hospital, Institution or
Z: City, Town or Village Warrensburg Street Address 16 Orton Drive
WI
E Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
14 Circumstances Investigation
ww Medical Certifier Name Title
gt Suzanne Bergin
Address
4a 3767 Main Street,Warrensburg,NY 12885
Death Certificate Filed District Number Register Number
City, Town or Village
❑Burial Date Cemetery or Crematory
June 13,2016 Pine View Crematory
❑Entombment Address
El Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
OI I Removal and/or Held
and/or Address
H Hold
u) -
0 Date Point of
05 n Transportation Shipment
p by Common Destination
Carrier _
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
: ; Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
' - 3809 Main Street,Warrensburg,NY 12885
r= Name of Funeral Firm Making Disposition or to Whom
E- Remains are Shipped, If Other than Above
• Address
1:4,
13
Permission is hereb granted to dispose of the human al s d cribed aabb e s indicated.
¢3 Date Issued Registrar of Vital Statis ' s -C �' ` vy'�`��
(signature)
District Number 5—zo 6 6 Place Q`` s to 7
„,
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition t(i3n/,� Place of Disposition Ojai--/ L t _
2' (address)
W
Cl)
0 (section) (Ipknumber) (grave number)
pName of Sexton or Person in Char a of Premises Art t
Z (please print)
W
Signature Title
(over)
DOH-1555 (02/2004)