Frasier, Gil D NEWYORKSTATEDEPARTMENTOFHEALTH s 1
Bureau of Vital Records Burial - Transit Permi
Name First Middle Last Sex
Gil D.Frasier Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/30/2023 61 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Thurman Town Street Address 8 Mud Street,Thurman Town,New York 12810
UJ
'p Manner of Death ❑X Natural Cause Accident In Homicide ESuicide Undetermined riPending
Circumstances Investigation
W Medical Certifier Name Title
0 Melanie Duerr NP
Address
47.Tom Phelps Lane,Mineville Hamlet,New York 12996
Death Certificate Filed Town Of Thurman District Number Register Number
City,Town or Village 5659 1
Burial Date Cemetery,Crematory or Facility Name
02/01/2023 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
ZO Removal Date Place Removed
and/or and/or Held
F.
Hold Address
0
O. Date Point of
Cl)❑Transportation
Q by Common Shipment
Carrier Destination
ODisinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
2 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/01/2023 Registrar of Vital Statistics Cynthia 2Z 7fyde(ECectronicautySigned)
(signature)
District Number 5659 Place Town Of Thurman
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition z)2l23 Place of Disposition L
LU
(address/
W
N
CC (section) 4 (lot number) (grave number)
gName of Sexton or Person in Charge of Premises
Z �•
(lease print)
W Signature Title 17.41(43)
DOH-1555(07/18)p 1 of 2
N f
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
•
Pine View Cemetery Representing the funeral home named pn,bt}rial permit
Official Funeral Directors Reg.or License#