Frasier, Janice NEW YORK STATE DEPARTMENT OF Hjg EALtH 'S
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Janice Marie Frasier Female
Date of Death Age If Veteran of U.S. Armed Forces,
03/14/2013 57 War or Dates
I Place of Death Hospital, Institution or l
5 City, � i Albany Street Address Albany Medical Center
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Manner of Death Natural Cause 0 Accident 0 Homicide 0 Suicide ❑Undetermined ❑Pending
WI Circumstances Investigation
W Medical Certifier Name Title
0 Ria Parullamo MD
Address
43 New Scottland Ave, Albany, NY 12208
Death Certificate Filed Alban District Number Register Number
City,XTPX y 101 Va
<>❑Burial Date Cemetery or Crematory
03/19/2013 Pine View Crematory
• ,❑Entombment Address
'i OCremation Queensbury, NY f o1-1¢Y
Date Place Removed
Z Removal and/or Held
9❑and/or
Address
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Hold
0
Date Point of
iTransportation Shipment
G by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
A' Name of Funeral Home Wilcox & Regan 01821
Address
11 Algonkin St. , Ticonderoga, NY 12883
Name of Funeral Firm Making Disposition or to Whom
1=I Remains are Shipped, If Other than Above
;2 Address
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Permission is hereby granted to dispose of the human remains described a above as indicated.
Date Issued D3M,/2d0 Registrar of Vital Statistics <
(signature)
District Number 101 Place Albany Police Station, Albany, New York I
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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ILI Date of Disposition 1--2_Z-13 Place of Disposition 0 >N Q_ \I t fil,vj CQ.(r 4+0gly
2 (address)
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C (section) ] lot number) (grave number)
Name of Sexton P son - arge of Premises SG u% lbw t
(please print)
Signature Title lei ri#'1 iziV— +,
(over)
DOH-1555 (02/2004)