Becraft, John 1
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NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
John Becraft Male
Date of Death Age If Veteran of U.S. Armed Forces,
January 26, 2017 99 War or Dates
,;- Place of Death Hospital, Institution or
2 City, Town or Village So. Glens Falls Street Address Home Of The Good Shepard
W.
ct Manner of Death X Natural Cause Accident I I Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Phillip J. Gara Dr.
Address
327 Broadway,Fort Edward,NY 12828
Death Certificate Filed District Number Register Number
City, Town or Village Town Of Moreau 4562 �1T/-
❑Burial Date Cemetery or Crematory
January 27, 2017 Pine View Crematorium
❑Entombment Address
❑x Cremation 51 Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
co
O Date Point of
coTransportation 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 Funeral Home 01444
Address
* 94 Saratoga Avenue, South Glens Falls, NY 12803
t Name of Funeral Firm Making Disposition or to Whom
• Remains are Shipped, If Other than Above
Address
111
• Permission is hereby granted to dispose of the human rema' escribe ab ve as indicated.
Date Issued 0//40 2.6( ) Registrar of Vital Statistics Jt Lf ;/ /I /
(sign re)
District Number 4562 Place Town Of Moreau
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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. Date of Disposition 1 Ji ill Place of Disposition Olt t.-- (rir\00,_.-
• (address)
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co
re (section) (lot number),, (grave number)
pName of Sexton or Person in Charge of Premises rF . t11ti'
Z lease print)
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Signature 4 Title Lf vntl-F2
(over)
DOH-1555 (02/2004)