Foster, Frances NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section { Burial - Transit�ermit
Name First Middle Last Sex
Frances C Foster Female
Date of Death Age If Veteran of U.S.Armed Forces,
i` February 21, 2016 92 War or Dates
2 Place of Death Hospital,Institution or
W City,Town,or Village Granville Street Address Indian River Rehabilitation and
G Manner of Death 0 Natural Cause El Accident El Homicide El Suicide 0 Undetermined ❑ Pending
W Circumstances investigation
(0 Medical Certifier Name Title
W Dr. Sean Bain Dr.
Cl Address
100 Park Street, Glens Falls, NY 12801
Death Certificate Filed District Number Registergumber
City,Town or Village Granville
❑Burial Date • Cemetery or Crematory
February 25, 2016 Pineview Crematorium
❑Entombment Address
Cremation Town of Queensbury Queensbury, NY 12804
Date Place Removed
0 ID Removal and/or Held
- and/or Address
I" Hold
0 Date Point of
4 [J Transportation Shipment
Da by Common Destination
Carrier
Date Cemetery Address
0 []Disinterment
❑Reinterment 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
fl
Remains are Shipped, If Other than Above
W Address
IL
Permission is here `y g anted to dispose of the human remain 4 ,es ' a s ov- - indicated.
Date Issued T�Q/� Registrar of Vital Statistics �1
nature)
District Number 57, Place Granville,New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2
� Date of Disposition 02/25/2016 Place of Disposition Pineview Crematorium
al
2 (address)
0
0 (section) ,4(ot number) r (grave number)
C Name of Sexton or Person in Charge of Pr ises N 3 ,xK
Ili �l� /(L�IN�(ple se print)
Signature IA. Title (
(over)
DOH-1555 (02/2004)