Bealmear,Colleen M. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Colleen M.Bealmear Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/07/2019 56 Years War or Dates
II.- Place of Death Hospital,Institution or
Z City,Town or Village Moreau Town Street Address 25 Skylark Drive A,Moreau Town,New York 12803
W Manner of Death Undetermined Pending
W ❑X Natural Cause Accident Homicide Suicide g
Circumstances Investigation
W Medical Certifier Name Title
G Alexis Mondella NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Moreau 4562 57
Burial Date Cemetery,Crematory or Facility Name
12/10/2019 Pine View Crematory
Entombment Address
aCremation Queensbury Town,New York
Donation
OZ Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
O
Date Point of
N Transportation
p by Common Shipment
d
Carrier Destination
El Disinterment
Date Cemetery Address
JE]Reinterment--�
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/10/2019 Registrar of Vital Statistics GeeannMcca&��Yectronic=5S4,neq)
(signature)
District Number 4562 Place Moreau, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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Z Date of Disposition 12 III I Place of Disposition v ( oFtuf—
Z (address)
W
N (section) A&number/ (grave number/
IX
gName of Sexton or Person in Charge of Premises /' 1*4tr
Z � ( ease print/
W Signature Title AVAM
DO H-1555(o7/18)p t of 2
Public Health Law Sec. 4145(2b) 0 '! 3 1 4 2
t Receipt
Human remains of r "' delivered on 20 ,
°; =, l
Pine View Cemetery Representing th ial home named on burial permit
Official Funeral Directors Reg.or License# `t
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