DeCrescente, Frank John NEWYORKSTATEDEPARTMENTOFHEALTH - i I DI
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Frank John DeCrescente Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/25/2021 72 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Fort Edward Village Street Address 50 Broadway B-4, Fort Edward Village, New York 12828
p Manner of Death EX] NaturalCause ❑Accident 0 Homicide Suicide Undetermined 0 Pending
Circumstances Investigation
W Medical Certifier Name Title
C Howard Silverberg MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Fort Edward 5755 6
❑Burial Date Cemetery,Crematory or Facility Name
01/27/2021 Pine View Crematory
Entombment Address
ElCremation Queensbury Town,New York
❑Donation
o ElRemoval Date Place Removed
and/or and/or Held
~ Hold Address
N
0
0.. Date Point of
(/) ❑Transportation
p by Common Shipment
Carrier gpstination
DisintermentEl
Cemetery Address
DateEl
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079
Address
82 Broadway,Fort Edward,New York 12828
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
"a Address
CC
W
EL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/27/2021 Registrar of Vital Statistics Aimee Mahoney(ECectronicalTySigned)
(signature)
District Number 5755 Place Fort Edward, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition I/Z61 1 Place of Disposition �'M
2 (address)
W
Cl) (section) /lot number) (grave number)
� �- s ,�
g r Name of Sexton or Person in Charge of Premis d� g" It
/plea e print/
W Signature � Title ` M �
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) J - 1 7
Receipt
Human remains of :.l }.' delivered on , 20
Pine View Cemetery Representing the funeral home named on buria1permit
Official Funeral Directors Reg.or License#