Frentzos, Kathryn NEW YORK STATE DEPARTMENT OF HEALTH A if 1�1
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Kathryn G. Frentzos Female
Date of Death Age If Veteran of U.S. Armed Forces,
June 2,2015 102 War or Dates World War II
i;, Place of Death Hospital, Institutiorliirondack Tri-County Health Care
Z City, Town or Village T/O Johnsburg Street Address Center
Wp Manner of Death X Natural Cause I I Accident I j Homicide Suicide Undetermined Pending
�J Circumstances Investigation
W Medical Certifier Name Title
G James Hindson Dr.
Address
Main St.,Warrensburg,NY 12885
Death Certificate Filed District Number Register Number
City, Town or Village T/O Johnsburg 5655 90
❑Burial Date Cemetery or Crematory
El
Entombment Pine View Crematory
Address
I Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z I I Removal and/or Held
and/or Address
t Hold
CO
0 Date Point of
0 Transportation Shipment
a 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 00035
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
.b. Remains are Shipped, If Other than Above
Address
IM
Permission is hereby granted to dispose of the human remains described bove as indicated.
Date Issued 3 Registrar of Vital Statistics ,. ._ , ,. L � O
' (signature) Y 1
District Number 5655 Place T/O Johnsburg,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z f a....- 4.40(1.
W Date of Disposition 6 l'il(s- Place of Disposition
2 (address)
W
U)
Ce (section) / ((lot number (grave number)
p Name of Sexton or Person in Charge of Premises 141
IZ (please print)
Signature /.. /4"- Title n/AA a,L-
(over)
DOH-1555 (02/2004)