Frazier, Thelma Loretta # 236
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Thelma Loretta Frazier Female
Date of Death Age If Veteran of U.S.Armed For ,
02/27/2021 90 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation
Ui
p Manner of Death ❑X Natural Cause Accident Homicide El Suicide ❑Undetermined Pending
✓ Circumstances Investigation
W Medical Certifier Name Title
Kenneth France MD
Address
170 Warren St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 122
❑Burial Date Cemetery,Crematory or Facility Name
03/02/2021 Pine View Crematory
0 Entombment Address
Cremation Queensbury Town,New York
❑Donation
OZ El Removal Date Place Removed
and/or and/or Held
N Hold Address
O -O. 1-1 Date Point of
CO Li Transportation
p by Common Shipment
Carrier Destination
El Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
1 Remains are Shipped,If Other than Above
Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/02/2021 Registrar of Vital Statistics t2o6erty?tdiew Curtis(EYectronicallyS#ned)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
Z Date of Disposition 3)14'zi Place of Disposition 11‘— 'ftj(1--
LLJ
2 (address)
W
N CC (section) (n number) (grave number)
O Name of Sexton or Person in Charge of Pr ises t"tQ` S'^"4
z (please int)
W Signature Title r!f��ktdd
DOH-1555(o7/18)p t of 2
1
Public Health Law Sec. 4145(2b) N144. 014603
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#