Nasr, Frieda Jane 11.0F
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Frieda Jane Nasr Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/14/2023 68 Years War or Dates
I— Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death ❑X Natural Cause Accident 0 Homicide Suicide ❑Undetermined El Pending
VCircumstances Investigation
WG Medical Certifier Name Title
Christopher Smith 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 252
A.Burial Date Cemetery,Crematory or Facility Name
05/17/2023 Pine View Cemetery
Entombment
_ Address
Cremation Queensbury Town,New York
Donation
Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
O. Date Point of
U)['Transportation
Q by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment 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
Ili
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/16/2023 Registrar of Vital Statistics Megan.Naln(4ctronrcallySigned
(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 - l_
z Date of Disposition L'1, 3 Place of Disposition r 14l_1n hz12 RD r:J—.I)S 6 A I/ /Y/ i
W /2 (address)
w 73 f
Qd. s n i e
(lot num r/ (grave number)
gName of Sexton or Person in Charge of Pre sr)i C-1 C) c
Z (please print)
IL Signature 4Title -.emu 1-)c)2\,R :SI 4,,.
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 012981
Receipt
1
Human remains of B-G/4 delivered on , 20
ne i Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
NASR LCe
Owner Lived In GF,NY
bra Tasr(social Servire) Sons; Zacharia, Fli and Joseph Nasr
Address Plot
111Fourth St. Queensbury, NY 12804 (Zacharia Nasr address) ERle.
Phone # Lot #
518-260-9223/ZAcharia 518-307-9438 Eli/ 51R-893-111c Joseph '73 F
Deed # Date
4384 5. 17.23
Cost Foundation Y - N
$800.00 pd by social service
Location
West-Vantassel
East-Kirsch
North-Raspante
South- LeFlure
Remarks
I ACKNOWLEDGE THE RECEIPT OF THE RULES AND REGULATIONS OF THE
PINE VIEW CEMETERY:
SIGNATURE: DATE:
SIGNATURE: DATE:
Record of Interments
1 •
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2 7
3 8
4 9
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NASR (14!)
Jane Nasr
NAME FriedaAge: 68
Lot Owner: Frieda Nasr (Socail Service)
Lot# Erie 73F Grave# 1
Case: Concrete
Died: 5. 1 4.2 3 Interred:
5. 17.23
Funeral Home: Singleton Sullivan Potter
Cemetery: Pine View