Hayes, Beatrice NEW YORK STATE DEPARTMENT DFHEALTH �����~��U ~ ���������~� �������^�
Bvmau�dB�uxoxi�kn ' Vha/ Records Se��n ��~~° w~�^ n ~ �~."~°ww Permit
Name First Middle Last Sex
Beatrice Hayes
Female
Date of Death
Age eteran of U.S. Armed Forces,
64 War or Dates No
Iz Place of Death Hospital, Institution or
IJj City,Town or Village Schuylerville Street Address 8 Burgoyne St
:Uj Medical Certifier Name Title
Q Jose.p.h Foote MD
Address
25 George Street Ft . Ann , NY 12827
Death Certificate Filed District Number Register Number
City,Town or Village Schuylerville
� Date Cemetery orCrematory
�lBurial Dec . 2 1988P'ne V'ew_ Cre���orI__----- ---'------~-----
C�makk�n ' Address .
! Oueeoabury, NY
- '°----...............................................---... ...------....P|���'n�����--------------------------------------^--
z Date
cz �� Remov� � � and/or Held
^- and/or Hold -----------'----.......~............. ................ ...............................................- ......---..................................
Fh
0 - -- ^ . ~~-~_-_ ~~~~~
' -- --------------------' Point of
' '
Date
wv Transportation by Shipment
C� Common Carrier ' ----- -_---__-_-----____.________________________________________________�_______________
Destination
-
Date ! Cemetery Address
[� Disinterment �
~~~~~~~~~~~~^�-.-.^.� ^-- ^-~~~~^-~~~~--.-__^.-~^-_~~-~~~'
{ "=e Cemetery Address
Fl R*i�ennenk
�
Permit Issued to Registration Number
Flynn Bros. Tnc.
Name of Funeral Firm 00829
Address
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Permission Is hereby granted to dispose of th d d h
aAc!ve as indicated.
9 ea uEa rem d��rlbod
-1-88 Registrar of Vital Statistics
Date Issued 12
ig
Schuylerville, NY
District Number Place
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
� �� � c��
Date ufDiupouit�n���-^°~/� /J Place ofDiupomihonLLJ
(address)
(section) (lot number) (grave number)
0 Name o/3 Person f Premis
z print)
. = Signature ~ Title
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