Fraser, Claire NEW YORK STATE DEPARTMENT OF HEALTH If go'
Vital Records Section 1 Burial - Transit Permit
Name First Middle Last Sex
Claire Ruth Fraser Female
Date of Death Age If Veteran of U.S. Armed Forces,
May 19, 2015 88 War or Dates
E'— Place of Death Hospital, Institution or
it City, Town or Village Fort Edward Street Address FORT HUDSON HCF
W Manner of Death X❑ Natural Cause ❑ Accident ❑Homicide ❑ Suicide ❑ Undetermined ❑ Pending
(, Circumstances Investigation
W. Medical Certifier Name Title
a Carrie Miran,
Address
9 Carey Road Queensbury, NY 12804
Death Certificate Filed District NumberRegisterNumber
City, Town or Village 5.7 3
❑Burial Date Cemetery or Crematory
June 1, 2015 Pine View Crematorium
0 Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
F and/or Address
,: Hold
tli;, Date Point of
R. ❑Transportation Shipment
(/) by Common Destination
Carrier
Date Cemetery Address
El Disinterment
t El Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
- Address
W
4 Permission is h reby granted to dispose of the hums em s described a as i icated.
Date Issued / /jam Registrar of Vital Statist' s
(signature)
District Numbe755-- Place /4,4,1 �jL � i h►
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
wDate of Disposition 06/01/2015 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
W
09
(section) /� (Iqt number) (grave number)
1 Name of Sexton or Person in Ch rge of Premises "�'�� �"�
( ease print)
LU Signature Title ( ""17'.
(over)
DOH-1555 (02/2004)