Bealmear, Dale NEW YORK STATE DEPARTMENT OF HEALTH
# 57Z-
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Dale E. Bealmear Male
Date of Death Age If Veteran of U.S. Armed Forces,
August 10,2016 64 War or Dates
Place of Death Hospital, Institution or
', City, Town or Village Lake George Street Address 85 Mohican Street
Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
ALL Circumstances Investigation
Medical Certifier Name Title
,fi: Alicia Earley FNP
Address
HH11N,Queensbury,NY 12804
Death Certificate Filed District Number Register Number
City, Town or Village Lake George 5620
❑Burial Date Cemetery or Crematory
❑Entombment August 11,2016 Pine View Crematory
Address
❑x Cremation 21 Quaker Rd., Queensbury, NY 12804
Date 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 Cemetery Address
r; Permit Issued to Registration Number
%'• Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg, NY 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
: '
Q Permission is hereby granted to dispose of the human re ains described above as indicated.
Date Issued V,jl l(q Registrar of Vital Statistics lCk ` , 1
(signature)
District Number 5620 Place V/O Lake George
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
p `z� �P Disposition1 /fie 1J t^ t-f 4ry
W Date of Disposition �/2-j Place of
W (address)
U)
CC (section) 1 (lo number) (grave number)
pName of Sexton or P son i Charge of Premises -)L.4.1 sue/ �h'lach.L
Z f please print)
W Signature �� Title / ^��Cv�a- -
(over)
DOH-1555 (02/2004)