Beckwith, Theresa Vivian NEW YORKSTATE DEPARTMENT OF HEALTH Burlal - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Theresa Vivian Beckwith Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/25/2020 72 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
p Manner of Death ❑K Natural Cause Accident Homicide Suicide Undetermined Pending
0 Circumstances Investigation
WC Medical Certifier Name Title
Diane Westbrook NP
Address
131 Lawrence St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 252
❑Burial Date Cemetery,Crematory or Facility Name
04/28/2020 Pine View Crematory
Entombment Address
0 Cremation Queensbury,New York
Donation
0 ❑Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
O
d Date Point of
N Transportation
p by Common Shipment
Carrier Destination
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan&Denny Funeral Service 01444
Address
94 Saratoga Ave,S Glens Falls,New York 12804
Name of Funeral Firm Making Disposition or to Whom
l~ Remains are Shipped,If Other than Above
Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/28/2020 Registrar of Vital Statistics .7olrn 2'aulFranck(-Yectronicalfy Stgued)
(sifflrature)
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: n
W Date of Disposition /-/-Z 0•Z0 ZO Place of Disposition ► e�chf y `�I'�Zl(jzty V C
L (a dress)
W
N r ion/ (lot number) (grave number)
O Name of Sexton or Pnersinarge of Premises
Z tprease print
LU rbR—
Signature Title
DOH-1555(07/18)p of 2
Public Health Law Sec. 4145(2b) 1 �'
1
1
Receipt
1
Human remains of delivered on , 20�_
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# ,