Beswick, Bettie NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
,.. ; Name First Middle Last Sex
Bettie P. Beswick Female
Date of Death Age If Veteran of U.S. Armed Forces,
t ' " February 27, 2012 96 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Fort Edward Street Address Fort Hudson Nursing Home
pManner of Death Natural Cause Accident Homicide Suicide Undetermined Pending
LI Circumstances Investigation
LI
w, Medical Certifier Name Title
Addressfill iezt_ trz .P. o�u e
Death Certificate Filed District Number Register Number
City, Town or Village Fort Edward ...5'75- Z3
II Burial Date Cemetery or Crematory
March 2, 2012 Pine View Cemetery
❑Entombment Address
❑Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
O and/or Address
H Hold
(i)
O Date Point of
NTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
I
Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Funeral Home 01444
Address
94 Saratoga Avenue, South Glens Falls,NY 12803
Name of Funeral Firm Making Disposition or to Whom
1- Remains are Shipped, If Other than Above
17 Address
C
W
Permission is reb granted to dispose of the human r ` airs described above s indicated.
Date Issued / Registrar of Vital Statistii i
(signature)
District Number Place Fort Edward
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 3/2/1 2 Place of Disposition Pine View Cemetery
W (address)
CO Hudson Sec. 2 20R 2
(section) (lot number) (grave number)
pName of Sexton or Pers in Charge of Premises Michael ( n ter
Z (please print)
W
Signature s Title Superini- ndnt
(over)
DOH-1555(02/2004)