Beebe, Rosemary NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section 4 `�' Burial - Transit Permit
Name First Middle Last Sex
Rosemary Helen Beebe Female
Date of Death Age If Veteran of U.S.Armed Forces,
I. September 5, 2016 War or Dates !956-1958
2 Place of Death Hospital, Institution or
W City,Town,or Village Granville Street Address The Orchard Nursing Centre, Inc.
G Manner of Death ®Natural Cause El Accident III Homicide ID Suicide D Undetermined ❑ Pending
W Circumstances Investigation
0 Medical Certifier Name Title
W Jennifer Hayes MD
d Address 1042 State Route 40 Granville New York 12832
Death Certificate Filed District Number Register Number
City,Town or Village Granville S'T56 3to
+❑Burial Date Cemetery or Crematory
September 8, 2016 Pineview Crematorium
❑Entombment Address
0 Cremation 21 Quaker Road Queensbury, NY 12804
Date Place Removed
aEl Removal and/or Held
- and/or Address
i" Hold
0 Date Point of
aEl Transportation Shipment
D. by Common Destination
Carrier
Date Cemetery Address
Disinterment
LI ❑Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Jillson Funeral Home, Inc. 00885
Address
46 Williams Street, Whitehall, New York 12887
~ Name of Funeral Firm Making Disposition or to Whom
x• Remains are Shipped, If Other than Above
W Address
0.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued o J0-i(aot6 Registrar of Vital Statistics vi mCiAT,QQ,�
(signs re)
District Number g"j$(o Place Granville,New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W
Date of Disposition 09/08/2016 Place of Disposition Pineview Crematorium
W (address)
II
d0 (section) /�� I_ot number) (grave number)
Name of Sexton or Person in Charge of Premises I(r1f{0 (*C 5i"11 ht.
Z (pleAse print)
W /� %re
Signature Title CR,Lh1ff'04L
(over)
DOH-1555 (02/2004)