Beshears, Denise M. 7.r4,
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Denise M Beshears I Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/13/2019 64 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital
p Manner of Death N10" atural Cause Accident Homicide Suicide Undetermined Ej
Pending
W Circumstances Investigation
U
W Medical Certifier Name Title
G Catherine Dawson MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 603
❑Burial Date Cemetery,Crematory or Facility Name
11/15/2019 Pineview Crematory
Entombment Address
RI Cremation Queensbury Town,New York
❑Donation
0 Removal Date Place Removed
and/or and/or Held
U) Hold Address
N
O
d Date Point of
to1:1 Transportation Shipment
Q by Common
Carrier Destination
Disinterment Date Cemetery Address
FjReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
Address
7 Sherman Ave,Corinth,New York 12822
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
� Address
M
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/14/2019 Registrar of Vital Statistics John Paul Franck(Electronically Signed)
(signature)
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 11 iS]11 Place of Disposition "' +4J rv—
WW (address)
W
N (sedion) (!ot number) (grave number)
0 Name of Sexton or Person in Charge of Premises nC
„n j lease print)
W Signature (/�/f// G`-/6 Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) ' 13 0 51-1
Receipt
Human remains of .' delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#