Bialas, Frederick NEW YORK STATE DEPARTMENT OF HEALTH !�
Vital Records Section Burial a Transit Permit
Name First Middle Last Sex
Frederick K Bialas Male
Date of Death Age If Veteran of U.S. Armed Forces,
June 28,2016 85 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
c) Manner of Death X Natural Cause Accident I I Homicide Suicide Undetermined Pending
Circumstances Investigation
, Medical Certifier Name Title
Robert W. Sponzo
Address
102 Park St.,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village C/O Glens Falls,NY 5601 3 3 2
❑Burial Date Cemetery or Crematory
❑Entombment June 30,2016 Pine View Crematory
Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z I I Removal and/or Held
and/or Address
H Hold
Cl)
0 Date Point of
N 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
Name of Funeral Firm Making Disposition or to Whom
lir-" Remains are Shipped, If Other than Above
16 Address
CK
tU
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 4/2 9 f / 6 Registrar of Vital Statistics LA.)Cam.
(& nature)
District Number 5601 Place C/O Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition C 13 IIb Place of Disposition gpt ��"•"l0—"
W (address)
N
(section) (Ipt num er), (grave number)
pName of Sexton or Person in Charge of Premises
Z (please print)
W Q
Signature Title h f 6
(over)
DOH-1555 (02/2004)