Fragassi, Joan NEW YORK STATE DEPARTMENT OF HEALTH 1 4 I
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Joan Fragassi Female
Date of Death Age If Veteran of U.S. Armed Forces,
October 31, 2013 78 War or Dates
t,., Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
3 Manner of Death 1 Natural Cause ❑Accident ❑Homicide ❑Suicide n Undetermined Pending
US Circumstances Investigation
La Medical Certifier Name Title
0
Address
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls,NY 5601 H 50
❑Burial Date Cemetery or Crematory
November 4, 2013 Pine View Crematory
❑Entombment Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
ZO ri❑Removal and/or Held
and/or Address
H Hold
CO
Q Date Point of
N ❑Transportation Shipment
a by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address iI
s
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued t t /i 1(3 Registrar of Vital Statistics U\.)- --iiCQS"--
(signature)
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance withthis permit on:
W Date of Disposition III S.Ii3 Place of Disposition '�1roVu,� Gr4orfr_-
2 (address)
W
Cl)
rt o (section) 4(lo umber) r (grave number)
QName of Sexton or Person in Charge of Premises r,s aolivlt
Z (ple a print)
ILI Signature Title C'IZEInf)tOf2
(over)
DOH-1555(02/2004)