Frye,William Joel 32 c
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Perrhit
Bureau of Vital Records
Name First Middle Last o Sex
_ William Joel Frye Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/30/2021 69 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Kingston Street Address Healthalliance Hospital Broadway Campus
▪ Manner of Death El Natural Cause Accident El Homicide 0 Suicide 111 Undetermined ❑Pending
W Circumstances Investigation
W• Medical Certifier Name Title
O Catherine Allen MD
Address
396 Broadway,Kingston, New York 12401
Death Certificate Filed District Number Register Number
City,Town or Village Kingston 5501 149
Burial Date Cemetery,Crematory or Facility Name
04/05/2021 Pine View Crematory
❑Entombment Address
X❑Cremation Queensbury Town,New York
0 Donation
IS
❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
n. Date Point of
Cl) ❑Transportation Shipment
p by Common
Carrier Destination
Date Cemetery Address
0 Disinterment
Date Cemetery Address
El Reinterment
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
H Remains are Shipped,If Other than Above
5 Address
CC
W
C' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/01/2021 Registrar of Vital Statistics Ehsa lint:.gketronicalySigne4
(signature)
District Number 5501 Place Kingston, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
�Z Date of Disposition II -4 L
Place of Disposition �,,,t
LU
2 (address)
W
N CC (section) (lot number) (grave number)
O• Name of Sexton or Person in Charge o remises �`�r ��"
(pleas print)
tL
z r ,4rie.
Signature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) = J
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#