Fragassi, Daniel NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section Last Sex Male
First Middle Fragassi
Name Daniel Age
Age If Veteran of U.S. Armed Forces,
Date of Death 11 1998 74 War or Dates
November Hospital, Institution or
<< Place of Death 5 Wait St
Glens Falls Street Address d Pending
>i`s Cit T� Undetermine
Suicide Circumstances ❑ Investigation
Homicide ❑
anner of Death®Natural Causes❑Accident ❑ ❑
Title
>< Medical Certifier Name
Andrew W. Garner ND
Address NY 12801
100 Broad St- r Glens Falls, Register Number
District Number —k d
Death Certificate Filed 5601
City, T Glens Falls
Cemetery or Crematory
Date 16, 1998 Pine View CrematoriLun
,' ❑ Burial November
Address NY 12804
® Cremation Tn of Queensbury,
Place Removed
Date and/or held
❑ Removal
and/or hold Address
Date Point of
❑ Transportation by
Shipment
Common Carrier Destination
Date Cemetery Address
❑ Disinterment
Date Cemetery Address
El Reinterment Registration Number
00313
<:Permit issued to Carleton Funeral Home Ina•
ame of Funeral Firm
Address Hudson Falls, N.Y. 12839
P.O. Box 67, 68 Main St. ,
sition
Remains are Shipped If Other Dthan o r to Whom
Name of Funeral Firm Making Above
<'Address
Permission is hereby granted to dispose of the human remains described abo a as indicat
#sDate Issu �� 9& Registrar of Vital Statistics (Signature)
5601 Glens Falls, NY
District Number---- Place
I certify that the remains of the decedent identified above weredis (osed of in accordance with this perton:
j/'/6../d Place of Disposition
Date of Dispositions---- (address)
(Section)
(Lot Number (Grave Number)
Name of Sexto or Person in Charge of Premises /Fblc� t
(Please Print)
Title
Signatur
V S-61
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