Bessey, Frances NEW YORK STATE DEPARTMENT OF HEALTH - Ilt #.3
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Frances C. Bessey F
Date of Death 0 5/01 /2 01 7 Age 7 6 If Veteran of U.S. Armed Forces,
War or Dates
E- Place of Death Hospital, Institution or
W
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
W Manner of Death Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
LucCircumstances Investigation
W Title
� Medical Certifier Name Heather Madigan MD
Address 211 Church Street, Saratoga Springs,NY 12866
Death Certificate Filed District Number Register Nunn) er
City, Town or Village Saratoga Springs q nl 7:7.,
Date Cemetery or Crematory
❑Burial 05/08/2017 Pine View Crematory
❑Entombment Address
Quaker Road, Quensbury,NY 12804
®Cremation
Date Place Removed
z I—I Removal and/or Held
O I I and/or Address
H Hold
CO Date Point of
eL ❑Transportation Shipment
(0 by Common Destination
5 Carrier
ElDisinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Heald Funeral Home 01 766
Address PO Box 282 7521 Court St, Elizabethtown,NY 12932
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
2 Address
IX
w
a. Permission is he by ranted to dispose of the human remains d ' ed bove in Gated.
Date Issued ic Registrar of Vital Statisticsj�
(signature)
District Number 1-1 5-b i Place S SK,����
F- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition �;I`5 11) Place of Disposition ,.4, 4 1..» 4e i, -
x (address)
W
IX (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises (1(11:)l,,,. �l AA of-
0
LUla (ple�se print)
W Signature 5----- Title li,,E.Iviv,..
(over)
DOH-1555 (02/2004)