Beeler, Francis NEW YORK STATE DEPARTMENT OF HEALTH ,. Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
FRANCIS BERNARD BEELER MALE
Date of Death Age If Veteran of U.S.Armed Forces,
04/15/2017 94 War or Dates
1- Place of Death Hospital, Institution
Z City , Town or Village City of Albany or Street Address COMMUNITY OF HOSPICE
W Manner of Death Natural
0 Undetermined Pending
W ® Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Circumstances ❑ Investigation
W Medical Certifier Name Title
CI YUN JEONG KIM MD
Address
315 S MANNING BLVD ALBANY NY 12208
Death Certificate Filed District Number Register Number
City, Town or Village City of Albany 101 878
Date Cemetery or Crematory
❑ Burial 04/18/2017 PINE VIEW CREMATORIUM
❑ Entombment Address
® Cremation QUEENSBURY NY
Date Place Removed
z Removal and/or Held
Q ❑ and/or Address
H Hold
(7
a Transportation Date Point of
Shipment
CO Carrier❑ By Common
O Destination
❑ Date Cemetery Address
Disinterment
❑ Date Cemetery Address
Reinterment
Permit Issued To Registration Number
Name of Funeral Home REGAN DENNY STAFFORD FH 01443
Address
53 QUAKER RD QUEENSBURY NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
LU
0- Permission is hereby granted to dispose of the human remains descri ,_d above asted.
Date
ed 04/17/2017 Registrar of Vital Statistics ; .I:�` t �r`-----"�-----
Issued
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition ��I�/7 Place of Disposition ??C(.), ) G.i2 ,72�t Ill
w (address)
E
w
co
tx (section) lot number) (grave number)
O
0
Z Name of Sexton or Person in Charge of Premises Lv/i.-- 4/1 6,et, K4 4-Gi
mr
(please print)
Signature f ' / ,e----------~ Title e. /le_714 acid
(over)
DOH-1555 (02/2004)