Frenya, Marie 711
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Trahsit Permit
Vital Records Section
Name First Middle Last Sex
MARIE ESTER FRENYA FEMALE
Date of Death Age If Veteran of U.S.Armed Forces,
* 02/24/2015 77 War or Dates
Place of Death Hospital, Institution
City,Town or Village City of Albany or Street Address ALBANY MEDICAL CENTER
Manner of Death ® Natural ❑ Accident ❑ Homicide ❑ Suicide 1-1 Undetermined ❑ Pending
Cause Circumstances Investigation
Medical Certifier Name Title
41 SEAN P. BOYLE MD
Address
43 NEW SCOTLAND AVE., ALBANY NY 12208
1,1
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 439
Date Cemetery or Crematory
❑ Burial 02/25/2015 PINE VIEW CREMATORY
0 Entombment Address
® Cremation QUEENSBURY, NY
Date Place Removed
Z Removal and/or Held
2 ❑ and/or Address
I- Hold
V)
O Date Point of
D._ Transportation Shipment
CO ❑ By Common Destination
a Carrier
0 Disinterment Date Cemetery Address
❑ Date Cemetery Address
Reinterment
• '.R Permit Issued To Registration Number
Name of Funeral Home M.B. KILMER F.H. 01079
• Address
y' 82 BROADWAY FORT EDWARD, NY 12828
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
®a
A. Permission is hereby granted to dispose of the human remains desc d above as indicated.
2'Z -
Date 02/24/2015 Registrar of Vital Statistics 1CQ t •Qi. /
• Issued (signature)
Irv.
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z' Date of Disposition 2/?6/15 Place of Disposition 'RNtVw` CrYsetof,".
w (address)
2
w
r (section) (lot number) (grave number)
Q
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Name of Sexton or Person in Charge of Premises A,i arr#
(please print)
Signature L Title (ta Itlet1 k
(over)
DOH-1555(02/2004)