Frasier, Noelle 10):
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Noelle Frasier Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/19/2023 83 Years War or Dates
i., Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address 2 Darwin Avenue,Glens Falls,New York 12801
p Manner of Death El Natural Cause Accident Homicide Suicide nUndetermined ❑Pending
W Circumstances Investigation
W Medical Certifier Name Title
G John Stoutenburg MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 205
l Burial Date Cemetery,Crematory or Facility Name
04/29/2023 Pine View Cemetery
Entombment
_ Address
Cremation Queensbury Town,New York
Donation
ZO❑Removal Date Place Removed
- and/or and/or Held
H- Hold Address
N
0 Date Point of
(I)Ill Transportation Shipment
Q by Common
Carrier Destination
Disinterment Date Cemetery Address
ElReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
i— Remains are Shipped,If Other than Above
2 Address
Q
W
D. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/20/2023 Registrar of Vital Statistics Megan.Wolin gCectronicat y Signed)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:I—
AA/
Z Date of DispositionK.I. - a3 Place of Disposition ;1 l()ula��2 "t�i1� • C.4)U�.e)S 1`_ L i(2801
2 (address) �/ /
co &wo (lot number) (grave number)
SName of Sexton or Person in Charge of Premi es f��'t `..' �e 2
z (pleaserkt)
W Signature I��/y�,,� .� Title c'`>L)/ r/ 0 C17
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
012977
Receipt
...er..
Human remains of iA`, '' delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
' Official Funeral Directors Reg.or License# -
Frasier
(j(;i,„
NAME Noelle Frasier Age: 83
Lot Owner: Marion H Frasier & Son
Lot# Wah Tah Wah 121 Sec 33 Grave# 14
Case: Concrete
Died: 4 . 1 9.2 3 Interred:4.2 9.2 3
Funeral Home: Regan Denny Stafford
Cemetery: Pine View
Lot No. 121
ddress Section No. 33
Glens Fa11x, N.Y.
Iwner Marion H. Frasier & Son Plot Wah_Ta_olah
late July 22, 1909
20 x 39 780 Superficial ft. @ 50¢ = 4390.00
ocation
s
lorner Posts
.emarks
Mt 3 darircr3
Teed No. (and changes) 121
ayment Record 8l'12/09