Loading...
Beede, Russ NEW YORK STATE DEPARTMENT OF HEALTH. "'.. t ` S I3 Vital Records Section Burial - TransitPermit Name First Middle Last Sex RUSS EDISON BEEDE MALE Date of Death Age If Veteran of U.S. Armed Forces, 11/30/11 63 War or Dates VIETNAM -1 Place of Death Hospital, Institution or , City, Town or Village NORTH ELBA Street Address ADR K WILDERNESS AREA UJ ADR K LOJ ROAD . Manner of Death ❑ Natural Cause ❑Accident ❑Homicide El Suicide ❑ Undetermined ❑Pending tki Circumstances Investigation la Medical Certifier Name Title C. FRAN(:TS VARGA, MD Address 303 LAKE PLACID CLUB WAY LAKE PLACID, NY 12946 Death Certificate Filed District Number Register Number City, Town or Village NORTH ELBA 1560 ^i ' ❑Burial Date Cemetery or Crematory DEC. 2, 2011 PINE VIEW CREMATORY ii ['Entombment Address ©Cremation GLENS FALLS, NY Date Place Removed Z 1-1❑Removal and/or Held and/or Address tit to Hold Date Point of 65 ❑Transportation Shipment a by Common Destination Carrier Q Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M. B. CLARK, INC. 01094 Address 2310 SARANAC AVE. , LAKE PLACID, NY 1 27 4 6 Name of Funeral Firm Making Disposition or to Whom I— Remains are Shipped, If Other than Above 2 Address CC t[f P' Permission is hereby granted to dispose of the human remai descr' ed ab e as indicated. Date Issued 12/2/11 Registrar of Vital Statistics \ twit (C / /U 2(tOl (signature) District Number 1560 Place 7 L of Afo -/ 1.43p i— I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z 1u Date of Disposition pa r�lit Place of Disposition ' tnsU ,1 Ctvpc'�ociu s (address) 11 CC (section) (lot numbe (grave number) ra Name of Sexton or Person in Char of Premises thr.A !"`siv z (please print) Signature 4fif14.., Title CU NI*O'il (over) DOH-1555 (02/2004)