Frasier, Harold NEW YORK STATE DEPARTMENT OF HEALTH * % S c
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Harold W Frasier Male
Date of Death Age If Veteran of U.S. Armed Forces,
12/15/2013 76 years War or Dates
Place of Death Hospital, Institution or
a City, Towwft*/iRXX GIPns Falls Street Address Glens Falls Hospital
Li Manner of Death❑ atural Cause ElAccident ❑Homicide 0 Suicide ❑Undetermined ❑Pending
W Circumstances Investigation
tu Medical Certifier Name Title
G Andrew Garner Corner
Address
8 Harrison Ave. Glens Falls, N Y 12801
Death Certificate Filed District Number Register Number
City, Tow (i/i. XX Glens Falls 5601 540
< Urn
Burial Date Cemetery or Crematory
❑Entombment 19/23/2013 Pine View Crematorium
Address
❑Cfemation Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
9 ❑and/or
H Address
Cl)
Hold
0 Date Point of
(':`0 Transportation Shipment
0 by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Edward L. Kelly Funeral Home 00519
Address
Schroon Lake, N Y 12870
Name of Funeral Firm Making Disposition or to Whom
F- Remains are Shipped, If Other than Above
Address
cr
ILI
IL
Permission is hereby granted to dispose of the human remains described aboye as indicated.
Date Issued 12/16/2013 Registrar of Vital Statistics 1, )c&& p
o (signature)
District Number Place (�
5601 GIPns Falls ) N
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
k �y^/) /�
� Date of Disposition i�-al-�i3 Place of Disposition ` u1� C""etor...,.
(address)
III
CO
CC (section) got nu ber) e(� (grave number)
Name of Sexton or Perso Charge of Premises ,
in ) t [wig"
(pleaprint)
Signature Title LY/fcMfa
(over)
DOH-1555 (02/2004)