Bevis Jr, John NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last ' Sex
John Edward Bevis Jr. Male
Date of Death Age &% If,Veteran of U.S. Armed Forces,
04 / 29 / 2017 _ : War or Dates Army 1976-1979
i- Place of Death t,.,. spite', Institution or
WCity, Town or Village Saratoga Street Address 104 County Road 68
0 Manner of Death®Natural Cause —Accident E Homicide Suicide Undetermined Pending
Ul — —Circumstances Investigation
tg Medical Certifier Name Title
0 John Delmonte MD
Address
3 Care Ln Suite 300, Saratoga Springs, NY 12866
Death Certificate Filed District Number vas- Register Number
City, Town or Village Saratoga 7,D
Burial Date Cemetery or Crematory
05 / 01 / 2016 1 Pine View Crematory
i ii; Entombment Address
Cremation Queensbury, NY
Date Place Removed
fi ❑Removal and/or Held
and/or Address
= Hold
V
0 Date Point of
Transportation Shipment
0 by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Q Renterment Date , Cemetery Address
ii!iiiPermit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Mi Address
402 Maple Ave. , Saratoga Sp. , NY 12866
gllii Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
Ui
"` Permission is hereby granted to dispose of the human remains described above as indicated.
iiE Date Issued s/i/07017 Registrar of Vital Statistics liC149.2 m (Q*— -/0 '
(signature)
ii District Number -5j(p 5 Place Saratoga , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
,1 Date of Disposition 61Li n Place of Disposition 'hnekli,r IPi 'Lo'+--
2 (address)
liii
Cr (section) /1 (lot number) (grave number)
Name of Sexton or Person in Charge of remises t '1r., f' 3t•;Ait
(p ase print)
Ul 4Title <r�fr+�ifit2��.
Signature
(over)
DOH-1555 (02/2004)