Beeman, David A +-IpLp
NEW YORK STATE DEPARTMENT OF HEALTH f i
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
David E. Beeman Male
Date of Death Age If Veteran of U.S. Armed Forces,
March 15, 2011 84 War or Dates
Place of Death ' Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
pManner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
AU Circumstances Investigation
CI
us Medical Certifier Name Title
an Paul Bachmann MD
Address
3767 Main Street Warrensburg NY 12885
Death Certificate Filed ! District Number 1 Register Number
a City, Town or Village Glens Falls 560 1 I 13
❑Burial Date Cemetery or Crematory
March 18, 2011 j Pine View Crematorium
❑Entombment Address
❑x Cremation 21 Quaker Road, Queensbury, NY 12804 ,
Date i Place Removed
Z Removal and/or Held
and/or Address
H Hold
N
O Date Point of
NTransportation Shipment
'p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment
Date 1 Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Funeral Home 01464
Address
53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
;k Remains are Shipped, If Other than Above
2 Address
.IY.
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IL
Permission is hereby granted to dispose of the human remains descri ed above ind' e .
Date Issued 311$ 1 i! Registrar of Vital Statistics �� ��
(signature)
District Number 5 60 t Place Glens Falls
I certify that the remains of the decedent identified above were dis osed of in accordance with this permit on:
Z I' /'
W Date of Disposition Y'Z711( Place of Disposition 0u U ", C.r ci-pPi4...
2 (address)
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Cl)
rt (section) a
��(lot numVa�"N� (grave number)
QName of Sexton or Person in Char of Premises f-) J
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7A (please print)
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Signature Title C�'FN+14 jot
(over)
DOH-1555(02/2004)