Sheehan, Frances 4 N .� itLR
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Frances J. Sheehan Female
Date of Death Age If Veteran of U.S. Armed Forces,
December 27,2012 79 War or Dates
i.., Place of Death Hospital, lnstitutiot 1irondack Tri-County Health Care
Z City, Town or Village Johnsburg j Street Address Center
uJ
p Manner of Death [X)Natural Cause [ }Accident I j Homicide Suicide [ I Undetermined Pending
tu Circumstances —Investigation
- ---------------------- —
G Medical Certifier Name Title
Thomas Warrington
Address ------___---- ---------_----
HIEHIN,Johnsburg,NY 12843
Death Certificate Filed I District Number ' Register Number
City, Town or Village Johnsburg I 5655 , 174
❑Burial Date Cemetery or Crematory
El Entombment December 31,2012 Pine View Crematory
Address
Ox Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
Cl)
O Date i Point of
N Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
j Reinterment
Date Cemetery Address
i
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
tom- Remains are Shipped, If Other than Above
a• Address
w
Q.
Permission is hereby granted to dispose of the human rem ins described ve as indicated.
Date Issued /02/31 j a Registrar of Vital Statistics
(signature)
District Number 5655 Place Johnsburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition (-2.4 Place of Disposition
ul (address)
O (section) ire
(tot number) (grave number)
Z Name of Sexton or Person in Charge of Premises
to I (please print)
Signatureitt;L... Title
(over)
DOH-1555 (02/2004)