Dittrich, Frank David A- 2%.5"
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NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Frank David Dittrich Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/12/2022 65 Years War or Dates
i,.. Place of Death Hospital,Institution or
WCity,Town or Village Lake George Town Street Address 3020 Lake Shore Drive,Lake George Town,New York 12845
O Manner of Death 1=1Natural Cause IllAccident El HomicideSuicide Undetermined Pending
0 Circumstances Investigation
W Medical Certifier Name Title
O Paul Bachman MD
Address
9 Carey Rd,Queensbury Town,New York 12804
Death Certificate Filed Town Of Lake George District Number Register Number
City,Town or Village 5651 22
Burial Date Cemetery,Crematory or Facility Name
12/14/2022 Pine View Crematory
Entombment Address
lICremation Queensbury,New York
DDonation
goRemoval Date Place Removed
and/or and/or Held
NHold Address
0
n. Date Point of
N Transportation Shipment
a by Common
Carrier Destination
Disinterment Date Cemetery Address
ElReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F. Remains are Shipped,If Other than Above
g Address
Q
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/14/2022 Registrar of Vital Statistics 2'atricia cR Mc`l(tnney-Schuster(ECectronicalfy Signed)
(signature)
District Number 5651 Place Town Of Lake George
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F.. /7
WDate of Disposition 12115 I zz. Place of Disposition ,4� car, ,
2 (address)
W
IE (section) A (lotnumber) (grave number)
0 Name of Sexton or Person in Charge of Premises 0
(pease print)
lL Signature Title !26/144 Z2
DOH-1555(07/18)p 1 of 2
. i"re,,,,9
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#