Copeland Sr, Frank NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
p Name First Diddle <-- , Last Sex
".: Frank C. w- Copeland, Sr. Male
: Date of Death Age If Veteran of U.S. Armed Forces,
p.°,jt'; August 30, 2016 93 War or Dates
r°.": Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death I XI Natural Cause I I Accident , Homicide 'Suicide Undetermined Pending
Circumstances Investigation
, Medical Certifier Name Title
Scott Biasetti
.a1 Address
100 Park Street,Glens Falls,NY 12801
;;; Death Certificate Filed District Number Register Number
. .� as)0\ gLA
.,..„ City, Town or Village Glens Falls, NY
..•❑Burial Date Cemetery or Crematory
August 31, 2016 Pine View Crematorium
❑Entombment Address
0 Cremation 51 Quaker Road,Queensbury,NY 12804
Date Place Removed
Z I I Removal and/or Held
O • and/or r Address
t: Hold
co
p Date Point of
NI I Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
•` Permit Issued to Registration Number
r ;' Name of Funeral Home Regan Denny Stafford Funeral Home 01443
'.0; Address
*h 53 Quaker Road, Queensbury,NY 12804
':. Name of Funeral Firm Making Disposition or to Whom
.•r Remains are Shipped, If Other than Above
Address
i
Permission is hereby granted to dispose of the human remains described above as indicated.
: Date Issued 13 F / /6 Registrar of Vital Statistics C A.i-v �. , nvAV
;.�•{ (signature
K* District Number 560 ) Place 6 Civ.S r-, \i S L•i{ L/J
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
w Date of Disposition /13i (IL Place of Disposition r ✓ �s +N.,'
2 (address)
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Q: (section) / (lot number)( (grave number)
QName of Sexton or Person in Charge of Premises `i JD*tilt
Z (please print)
W a. . Title t MfT1L
Signature
(over)
DOH-1555(02/2004)