Frasier, Alice NEW YORK STATE DEPARTMENT OF HEALTH # f qL
Vital Records Section Ar- li
Burial - Transit Permit
Name First Middle Last Sex
Alice Ann Frasier Female
Date of Death Age If Veteran of U.S. Armed Forces,
March 8,2015 64 War or Dates
. Place of Death Hospital, Institution or
Z City, Town or Village Warrensburg Street Address 50 Warren Street
pManner of Death X Natural Cause Accident I Homicide Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
G Suzanne Bergin
Address
3767 Main Street,Warrensburg,NY 12885
Death Certificate Filed District Number Register Number
City, Town or Village Warrensburg 5660
❑Burial Date Cemetery or Crematory
March 13,2015 Pine View Crematory
❑Entombment Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
I' Hold
u)
0 Date Point of
N I I Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
1-1 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
!- Remains are Shipped, If Other than Above
2 Address
tY
W
Permission is here y granted to dispose of the human r s described_ bove as indicated.
Date Issued .��/ 5� Registrar of Vital Statisti /72�-.
(signature)
District Number 5660 Place Warrensburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z I�W Date of Disposition 3Jirdl iS Place of Disposition go..., C,..._toy„„_
W (address)
U)
CL (section) •4.,
(lot numbe (grave number)
a Name of Sexton or Person in Charge of Premises 34,4frt
Z / (please print)
w Signature A %�J�— Title (014411 (,
(over)
DOH-1555 (02/2004)