Bearce Jr., Charles 1 r /1
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
!: Name First Middle Last Sex
Charles Gorden Bearce Jr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
02 / 01 / 2018 77 War or Dates 1962-1966
Place of Death Hospital, Institution or
ZCity, Town or Village Greenfield ,x t Address 103 Squashville Road
a Manner of Death illy"Natural Cause ElAc• ;'cide 0 Suicide 0 Undetermined 0 Pending
lajCircumstances Investigation
tu Medical Certifier Name Title
0 Hung Dinh Nguy MD
Address
19 West Avenue Saratoga Springs, NY 12866
Death Certificate Filed District Number Register Number
City, Town or Village Greenfield
0Burial Date 02 / 07 / 2018 Cemetery or Crematory
WPMEntombment r Pine View Crematory
Address i
Cremation Queensbury, Ni..
ii Date Place Removed
❑Removal and/or Held
and/or Address
Hold
VO
0 Date Point of
0 Transportation Shipment
by Common Destination
Carrier
�]Disinterment Date Cemetery Address
Ai
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
M: Address
402 Maple Ave., Saratoga Sp. , NY 12866
'.,,, Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Ill
04 Permission is hereby granted to dispose of the human re ains described above as indicated.
II Date Issued -3 -s-xi B Registrar of Vital Statistics S. ' )011.e-e-^Wi �
(signature)
District Number IAssl Place Greenfield , New York
'' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
10 Date of Disposition Z 11 lig Place of Disposition 6.4V-*/ t&- ..
2 (address)
c
et (section) (4lot number) (grave number)
CIName of Sexton or Person in Charge of Pr ises ��*�
(pi ase print) .
Si nature Title 43FfiflCV -
(over)
DOH-1555 (02/2004)