Waite, Frank Edgar Jr. LE
it SSA
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Frank Edgar Waite Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/11/2022 60 Years War or Dates
H Place of Death Hospital,Institution or
W City,Town or Village Kingsbury Town Street Address 15 Tenth Avenue,Kingsbury Town,New York 12839
O Manner of Death ❑X Natural Cause []Accident Homicide Suicide Undetermined ❑Pending
0Circumstances Investigation
W Medical Certifier Name Title
O Jean Hanson PA
Address
325 Main Street,Hudson Falls Village,New York 12839
Death Certificate Filed Town Of Kingsbury District Number Register Number
City,Town or Village 5762 14
Burial Date Cemetery,Crematory or Facility Name
07/14/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
EiDonation
o[]Removal Date Place Removed
and/or and/or Held
N Hold Address
O
Date Point of
(/)❑Transportation
CI Common Shipment
Carrier Destination
ElDisinterment Date Cemetery Address
Date Cemetery Address
E Reinterment
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
1-- Remains are Shipped,If Other than Above
2 Address
Q
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/14/2022 Registrar of Vital Statistics Cynthia Banfin(ECectronicafySigned)
(signature)
District Number 5762 Place Town Of Kingsbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
IJJ Date of Disposition & ZL Place of Disposition ,,5E (fie, �� CrejttaF,4,:s 4-�
(address)
uJ
N CC (section) (tot numb r/ (grave number)
,/
8 Name of Sexton or Person in Charge of P emise �A 1 N'10:+/1)
Z 1 (please print)
W Signature Title open GT�r
DOH-1555(o7/18)p t of 2 t1l
• R
Public Health Law Sec. 4145(2b) t.
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License#