Light, Frederick i II
NEW YORK STATE DEPARTMENT OF HEALTH
# St
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Frederick J. Light Male
Date of Death 0 Age If Veteran of U.S. Armed Forces,
10/4/13 72 War or Dates No
1.- Place of Death Hospital, Institution orNathan Littauer Hospital
City, Town or Village Gloversville Street Address 99 E.State St. Gloversville, NY
• Manner of Death®Natural Cause El Accident El Homicide D Suicide ❑Undetermined 0 Pending
Ili Circumstances Investigation
W Medical Certifier Name Title
0 Margaret E. Luch Coroner
Address
223 W. Main St. Johnstown, NY
Death Certificate Filed District Number 17 01 Register Number 225
City, Town or Village Gloversville
s> z ❑Burial Date Cemetery or Crematory
QEntomCment 10/7/13 Pine View Crematory
Address
®Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
g❑Removal and/or Held
2 and/or Address
M=" Hold
to
O Date Point of
0 Li Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home 01 078
Address
136 Main St. So. Glens Falls, NY 12803
Name of Funeral Firm Making Disposition or to Whom
• Remains are Shipped, If Other than Above
• Address
t
141
• Permission is hereby granted to dispose of the human remains described a ve ' dicated.
it Date Issued 10/0 7/2 013 Registrar of Vital Statistics d 1 Ple.....1____________
(signature)
District Number 1701 Place Gloversville
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
p r 1/Ii3 DispositionR L) C,,.,.etas,....
I�• Date of Disposition o Place of „� k,,,�
l (address)
te
Ili (section) (lot mber) (grave number)
0
III Name of Sexton or Person i Charge of Premises not St�.4r4•
z (please pri t)
iiiSignature r� /(,-- Title CaE++stTtic
(over)
DOH-1555 (02/2004)