Frazier Jr, Joseph ( 1. � �33
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
7 Name First Middle Last Sex
Joseph Daniel Frazier,Jr Male
'`` Date of Death Age If Veteran of U.S. Armed Forces,
December 3, 2013 69 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address 27 Tuscarora Drive
Manner of Death ❑X Natural Cause ❑Accident ❑Homicide n Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
lij Robert Sponzo,MD
Address
Glens Falls,NY
Death Certificate Filed District Number Register ,Number
f, City, Town or Village Queensbury,NY 5657 ) '
❑Burial Date Cemetery or Crematory
December 4, 2013 Pine View Crematorium
❑Entombment Address
1i Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
ZO ❑Removal and/or Held
and/or Address
t' Hold
N
O Date Point of
NElTransportation Shipment
p by Common Destination
Carrier
El
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
-- Permit Issued to Registration Number
f„ Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
;. Address
407 Bay Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
' Remains are Shipped, If Other than Above
Address
I
' Permission is hereby granted to dispose of the human r mains described ove as indicated.
;i(I
Date Issued 14/ 3 Registrar of Vital Statistics �_ CL LS��
(signature)
District Number 5657 Place Queensbury,NY
I certify that the remains of the decedent identified above were disposed of in accordancec with this permit on:
wDate of Disposition fz-b--j3 Place of Disposition 't�ntt. LJ 4 iJvcid6,_
2 (address)
W
Cl)
CL (section) (lot nu ber) (grave number)
pName of Sexton or Person ' Charge of Premises ,r�s'1U2Cer �r wit.
Z j (please print)
W
Signature JIjT Title Cif Nt
(over)
DOH-1555(02/2004)