Beaton, Joan f
r
66
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Joan Beaton Female
r'>r Date of Death Age If Veteran of U.S. Armed Forces,
• `• r March 21, 2017 93 War or Dates 1943-1945
• Place of Death Hospital, Institution or
• City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death XXNatural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
w Medical Certifier Name Title
a Suzanne Blood MD
Address 161 Carey Rd. Queensbury, NY 12804
Death Certificate Filed District Number 1✓ Register Number
5
City, Town or Village Glens Falls, NY )0 I ) g
❑Burial Date Cemetery or Crematory
March 23, 2017 Pine View Crematorium
❑Entombment Address
❑x Cremation 51 Quaker Road, Queensbury, NY 12804
Date Place Removed
Z I I Removal and/or Held
and/or Address
H Hold
N
O Date Point of
05 I I Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
} Remains are Shipped, If Other than Above
AAddress
` Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 3( 2' / (-2 Registrar of Vital Statistics L& lY\SL. t..,)
(signa_„� t�Ne)
District Number 5 6 C i Place 4' �aA/\i rO,, 0 S r tiny
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition, z /3 f7 Place of Disposition i r 2�t�,'; ,� (:�..,4 r cti-10(
Z
2 (address)
W
Cl)
cc (section) (lot number) (grave number)
pName of Sexton or Person in Charge of Premises L.. I C.. i,i Cr r'.,4v(c l t
Z (please print)
W
Signature / �G. � Title C `' ✓j24,- !
(over)
DOH-1555 (02/2004)