Paradis, Frances D. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
slt Name First Middle Last Sex
v
�� Frances D.Paradis Female
,' Date of Death Age If Veteran of U.S.Armed Forces,
01/20/2021 87 Years War or Dates
=_ Place of Death Hospital,Institution or
WCity,Town or Village Minerva Town Street Address 974 14th Road,Minerva Town,New York 12851
`0 Manner of Death rig] NaturalCause ID Accident ❑Homicide ❑Suicide Undetermined ❑Pending
Circumstances Investigation
1.1
W Medical Certifier Name Title
fir Jennifer Stratton MD
,, = Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Olmstedville 1557 9
Burial Date Cemetery,Crematory or Facility Name
`.'; 01/23/2021 Pine View Crematory
_` Entombment Address
0 Cremation Queensbury Town,New York
, L j Donation
• Removal Date Place Removed
and/or and/or Held
p Hold Address
0
0` Date Point of
CO ❑Transportation Shipment
Q by Common
Carrier Destination
,i
▪ ❑Disinterment
Date Cemetery Address
„!❑Reinterment
Date Cemetery Address
iJ Permit Issued to Registration Number
` f' Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
-▪ Name of Funeral Firm Making Disposition or to Whom
p_ Remains are Shipped,If Other than Above
2 Address
CC
W
, Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/22/2021 Registrar of Vital Statistics 'Diana Mason(ECectronica1TySigned)
(signature)
z District Number 1557 Place Olmstedville, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F
W Date of Disposition I�ZS a Z) Place of Disposition 21L G�,'�a-�—
2 (address)
W
Ncc (section) (lot numbers (grave number)
• Name of Sexton or Person in Charg!Premi
ses (plea3eprint)
kr Signature Title lr4r"$4}�C.
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) - ` '
Receipt
Human remains of delivered on - , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# a.