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Beecher, Robert Hamilton
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert Hamilton Beecher Male Date of Death Age If Veteran of U.S.Armed Forces, 12/14/2019 52 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Mannerof Deathuj © Natural Cause Accident Homicide Suicide Undetermined Pending 0 Circumstances Investigation WQ Medical Certifier Name Title Sean Bain MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 537 Burial Date Cemetery,Crematory or Facility Name 12/20/2019 Pine View Crematory Entombment Address ICremation Queensbury Town,New York Donation ZO Removal Date Place Removed and/or and/or Held U) Hold Address O 0. U) Transportation Date Point of p by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address 0 Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom F Remains are Shipped,If Otherthan Above Address W (L Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/16/2019 Registrar of Vital Statistics Wpbe7t,4ndrew Curtis(ECectronicalTy Signer!) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition Place of DispositionUj 2 (address) W N M (section) (/t number) (grave number) gName of Sexton or PersZinharge of mises � .JW �� (Please print) Signature Title DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) 013167 Receipt Human remains of `'' `� ' i delivered on 1 "' " , 20 Pine View Cemetery Representing the fune#al Koxne named on burial permit Official Funeral Directors Reg.or License# "` '