Hill, Frank lawrence NEW YORK STATE DEPARTMENT OF HEALTH [... .. ff?cr
Bureau of Vital Records Burial - Transit Permit
Name First Middle
Last I Sex
Frank Lawrence Hill
Date of Death Male
Age I If Veteran of U.S.Armed Forces,
09/04/2022 84 Years War or Dates
i— Place of Death Hospital,Institution or
WCity,Town or Village Horicon Town I Street Address 1041 Valentine Pond Road,Horicon Town,New York 12808
Q Manner of Death 0 Natural Cause
W X Accident Homicide Suicide Undetermined ❑Pending
U Circumstances Investigation
CI Medical Certifier Name
Title
Mark Hoffman MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed Town Of Horicon District Number
City,Town or Village Register Number
5654 2
Burial Entombment Date I Cemetery,Crematory or Facility Name
09/06/2022 Pine View Crematorium
Address
aCremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
F, and/or and/or Held
N Hold Address
0
a Date Point of
COWO Transportation
CI by Common Shipment
Carrier Destination
ODisinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to
Registration Number
Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141
Address
9 Pine St,Chestertown,New York 12817
Name of Funeral Firm Making Disposition or to Whom
E-. Remains are Shipped,If Other than Above
2 Address
CC
111
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/06/2022 Registrar of Vital Statistics 7(rista L Wood YECectronicaQySigned)
(signature/
District Number 5654 Place Town Of Horicon
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z l� �* �
W Date of Disposition I h I ZZ Place of Disposition
(address)
W
Cl) (section) (lot number) (grave number)
CC Name of Sexton or Person in Charge of Premises A t", ! l� _c_simi
jf
Z (pase print/
W Signature L Title l��f�m� �
D0 H-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on I: , 20
r
Pine View Cemetery Representing the fineral home named on burial permit
Official Funeral Directors Reg.or License#/, "�.. C.'