Grabowski, Frank NEW YORK STATE DEPARTMENT OF HEALI+H 8 # Z&jj
Vital Records Section Burial - Transit Permit
`: Name First Middle Last Sex
Frank J. Grabowski Male
Date of Death Age If Veteran of U.S. Armed Forces,
April 24, 2013 71 War or Dates
1
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death ❑X Natural Cause n Accident ❑Homicide n Suicide n Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
,a- Mark Hoffman,MD
Address
Glens Falls,NY
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls,NY 5601 l 1 -6
❑Burial Date Cemetery or Crematory
April 29, 2013 Pine View Crematory
❑Entombment Address
0 Cremation Quaker Road, Queensbury, NY
Date Place Removed
Z n Removal and/or Held
O and/or Address
H Hold
CO
0 Date Point of
N ❑Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
` ` Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Road, Queensbury,NY 12804
ors Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
4 Permission is hereby granted to dispose of the human remains described above as indicated.
%,.
'tf Date Issued ' J 1 `-1113 Registrar of Vital Statistics C v� \. .)
,''': (signature)
" District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordanceCrewe
with this permit on:
W Date of Disposition 11`,3O-13 Place of Disposition Zan.) Crr wetotw_._
2 (address)
W
Ce O (section) A (lot numbeS (grave number)
p Name of Sexton or P rson in Charg of Premises) Gi`rlg-
Z (please print)
W Signature Title Ct1No(
(over)
DOH-1555(02/2004)