Carberry, Frank 41 45Z
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
'...., Name First Middle Last Sex
:,;.;.',0 Frank James Carberry Male
' 1 Date of Death Age If Veteran of U.S. Armed Forces,
i,.; July 21, 2014 50 War or Dates
°• ' Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address 7203 Regency Park North
Manner of Death Natural Cause Accident Homicide [ Suicide X Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
.: Paul Bachman
Address
13767 Main Street,Warrensburg,NY 12885
°▪• Death Certificate Filed District Number aster Number
• City, Town or Village Queensbury 5657 0
❑Burial Date Cemetery or Crematory
July 24, 2014 Pine View Crematory
❑Entombment Address
0 Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
O and/or Address
H Hold
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0 Date Point of
N I 1 Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
:;:;: Permit Issued to Registration Number
. Name of Funeral Home Regan Denny Stafford Funeral Home 01443
::: Address
i 53 Quaker Road, Queensbury,NY 12804
„ Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
-r
:,::: Permission is hereby granted to dispose of the human r m re ins described a o as indicated.
;i: Date Issued Ie -1 Registrar of Vital Statistics 4�C-----___Ck. (
(signature)
:.t: District Number 5657 Place Queensbury
F. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z c., C. br
Ili Date of Disposition �-2K(y Place of Disposition tM�
2 (address)
W
CL
(section) (lo umb r) (grave number)
O Name of Sexton or Person in Char a of Premises `, % St'i^sg
W (please print)
Signature Title r
(over)
DOH-1555(02/2004)