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Sprague, Frank NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Frank W. Sprague Male Date of Death Age If Veteran of U.S. Armed Forces, $: October 2,2014 90 War or Dates g Place of Death Hospital, Institution or sa" City, Town or Village Fort Edward Street Address Fort Hudson Health Care Facility Manner of Death �1 — Undetermined Pending 14 I�I Natural Cause Accident n Homicide Suicide Circumstances Investigation Medical Certifier Name Title Philip J. Gara Jr. :- Address 327 Broadway,Fort Edward,NY ins Death Certificate Filed District Number Regi�.ter ber City, Town or Village Fort Edward 5755 (/y_ ❑Burial Date Cemetery or Crematory October 6,2014 Pine View Crematory ❑Entombment Address N Cremation 21 Quaker Rd., Queensbury,NY 12804 Date Place Removed Z I 'Removal and/or Held and/or Address L Hold U) © Date Point of Nn Transportation Shipment a by Common Destination Carrier Disinterment Date Cemetery Address n Reinterment Date Cemetery Address Permit Issued to Registration Number • Name of Funeral Home Alexander-Baker Funeral Home 00035 • t Address • 3809 Main Street,Warrensburg,NY 12885 e Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address XO . Permission is he b gr ted to dispose of the human re 'ns described a ove indicated. br Date Issued/d i� / Registrar of Vital Stati tics (signet re) va ;• District Number 5755 Place Fort Edward I certify that the remains of the decedent identified above were disposed of inni accordance with this permit on: W it nu Date of Disposition 10/11)1 Place of Disposition v C+i,r46r,v-- 2 (address) W O' (section) lot number) (grave number) p Name of Sexton or Person in Charge of Premises ,.5.,. ? Z (please print) w Signature �K Title tire fipiu (over) DOH-1555(02/2004)