Bessett Jr, George NEW YORK STATE DEPARTMENT OF HEALTH ' 3g�
Vital Records Section t Burial - Transit Permit
Niii Name First Middle Last Sex
in
George .T_osnph B ssette, Jr_ Mal e
li Date of Death Age If Veteran of U.S. Armed Forces,
''` JunP 1 5, 201 4 60 yrs_ War or Dates No
Place of Death Town of Hospital, Institution or
City, Town or Village Putnam Station Street Address 1 08 County Rte. 1
Manner of Death ®Natural Cause ❑Accident ❑Homicide 0 Suicide El Undetermined ni Pending
Circumstances Investigation
41 Medical Certifier Name Title
Max Grossman M.D.
Address
65 Poultney Street, Whitehall, NY 12887
''''>` Death Certificate Filed Town of District Number Register Number
'> City, Town or Village Putnam Station 5763 3
Date Cemetery or Crematory
❑Burial 06/18/2014 Pine View Crematory
Address
Cremation Queensbury, New York
Date Place Removed
0❑Removal and/or Held
and/or Address
gHold
Q Date Point of
NQ Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment I Date Cemetery Address
Permit Issued to Registration Number
gip Name of Funeral Home Wilcox & Regan funeral home 01 821
Address
iHil 11 Algonkin St. , Ticonderoga, NY 12883
RO Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
f7i
N) Permission is hereby granted to dispose of the human rem s described above as indicated.
Date Issued 0 6/1 8/201 4 Registrar of Vital Statistics
Lf/t24-o)c '
(signature)
District Number tj 763 Place Town of Putnam Station
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
f ,� Q
Date of Disposition / Place of Disposition 4711XK� L r�s't --
441 (v/� 1�
2 (address)
41
U)
CC (section) ,J(lotnumber (grave number)
0 Name of Sexton or Person in Charge of Premises 6/�,�y oWO-
g /� (please print) ]�
U: Signature v'��L ATitle C4011401
DOH-1555 (10/89) p. 1 of 2 VS-61