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Beahan, Andrea NEW YORK STATE DEPARTMENT OF HEALTH It 13 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Andrea Beahan Female Date of Death Age I If Veteran of U.S. Armed Forces, June 3, 2017 56 War or Dates F- Plac of Death Hospital, Institution or W City, own or Village Kingsbury Street Address 110 Deer Run Drive W Manner eath Natural Cause pi Natural ❑ Homicide El Suicide ❑ Undetermined X❑ Pending Circumstances Investigation W Medical Certifier Name Title ] Michael Sikirica MD, Address 50 Broad Street Waterford, NY 12188 Death ertificate Filed District Number Register Number City,' own 'r Village 43 ne1 sbvirr? 5 i. /) ❑ Burial Date Cemetery or Crematory June 6, 2017 Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z I—I Removal and/or Held l 1 and/or Address F- Hold 17 Date Point of Transportation Shipment Grp by Common Destination D Carrier Date Cemetery Address ❑ Disinterment Date Cemetery Address El Reinterment Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom I- Remains are Shipped, If Other than Above 2 Address Et W Lt. Permission is hereby granted to dispose of the human remains described above as indicated. Date issued 6 /6, /t 7 Registrar of Vital Statistics c Cc (j._,_(', rti (signature) District Number 3 -1 G,)_ Place /p4t.h ( lc , /1 S /�c r) I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F- W Date of Disposition 06/06/2017 Place of Disposition Quaker Road Queensbury,NY 12804 2 (address) W i (section) {'%(lot number) (grave number) Name of Sexton or Person in Charge of remises L iti'►ti Z (phase print) W Signature 4AO Title atiVIAD.L. (over) DOH-1555 (02/2004)