Webster, Becky •
NEW YORK STATE DEPARTMENT OF HEALTH rr)
Vital Records Section Burial - Transit Permit
Name First Middle Last I Sex
Becky Webster I Female
Date of Death Age If Veteran of U.S. Armed Forces,
August 4, 2011 ! 51 War or Dates
E. Place of Death I Hospital, Institution or
Z City, Town or Village Fort Edward j Street Address Fort Hudson Nursing Home
aManner of Death X Natural Cause Accident I I Homicide Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
C! Philip Gara,MD
Address
327 Broadway,Ft.Edward,NY
Death Certificate Filed I District Number Regis er Number
City, Town or Village Ft.Edward ..2c5----
❑Burial Date 1 Cemetery or Crematory
❑Entombment August 5, 2011 ! Pine View Crematorium
Address
❑x Cremation 21 Quaker Road, Queensbury,NY 12804
Date j Place Removed
Z Removal and/or Held
and/or Address
H Hold
N
0 Date Point of
N Transportation Shipment
p by Common Destination
Carrier
Disinterment Date ; Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan& Denny Funeral Home 1 01443
Address
53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
i- Remains are Shipped, If Other than Above
E Address
Hi
O. Permission is he eby ranted to dispose of the human r ains described above a indicated./
Date Issued / Registrar of Vital Statistics( D/
(signature)
District Number 1'"'75-- Place Ft.Edward
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z /�
W Date of Disposition V i-tA Place of Disposition P4 Ui,W Cam*°t ,lice
W (address)
co
w (section) ,) ( (lot nu er) (grave number)
pName of Sexton or P son in Charg of Premises C A,(
W (please print)
Signature Title Seri m ok...
(over)
DOH-1555(02/2004)