Bechard, Roger ,r
1 ' 4/ ug
NEW YORK STATE DEPARTMENT OF HEALTH , Burial Transit Permit
Vital Records Section
Name First Middle Last Sex
Roger Bechard Male
'> Date of Death Age If Veteran of U.S. Armed Forces,
03 / 09 / 2018 56 War or Dates N/A
}•- Place of Death Hospital, Institution or
City, Town or Village Town Street Address 422 Northern Pines Road
Ui
a Manner of Death❑Natural Cause E Accident ❑Homicide E Suicide 0 Undetermined Pending
Uit Circumstances Investigation
ul Medical Certifier Name Title
0 Michael Sikirica MD
Address
50 Broad St, Waterford, NY 12188
ni Death Certificate Filed District Number 461.Pq Register Nu ber
City, Town or Village Tom /
®Burial Date Cemetery or Crematory
03 / 14/ 2018
Entombment Pine View Crematory
Address
ECremation Queensbury, NY
Date Place Removed
❑Removal and/or Held
and/or Address
Hold L
Date Point of
Q Transportation Shipment
C by Common Destination
Carrier
'j 'Q Disinterment Date Cemetery Address
iN
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number A ,
1.1 Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave., Saratoga Sp. , NY 12866
ei
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
SI Address
i
ill
Permission is he eby granted to dispose of the human rem 'ns described above as indicated./ ldi
,,
Date Issued Registrar of Vital Statistics Cat (C �CLI.v C�
signature)
District Number LP"/ Place Town , New York
'° I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z p
Ili Date of Disposition 3)t14 III Place of Disposition 'f,,,, .. 4_4_
(address)
ILI
Cr (section) //1 (lot number) ( (grave number)
IIName of Sexton or Person in Charge f Premises . !/ ,.. l_ J"-�'r
Z • (pease pnnt) - to
Signature tu G✓ Title €'tlWIZ.
(over)
DOH-1555 (02/2004)