Beadnell, Brenda s 7r "Of I NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
x Brenda J. Beadnell Female
"ff= Date of Death Age If Veteran of U.S. Armed Forces,
July 9,2014 72 War or Dates
Place of Death Hospital, Institution or
riCity, Town or Village Warrensburg Street Address 44 James St.
° Manner of Death
n Natural Cause I I Accident n Homicide n Suicide �Undetermined Pending
r Circumstances Investigation_
S Medical Certifier Name Title
Donald R. Merrihew
x.*°: Address
319 Bay Road,Queensbury,NY 12804
'` Death Certificate Filed District Number Register Number
>: City, Town or Village Warrensburg 5660
❑Burial Date Cemetery or Crematory
❑Entombment July 11,2014 Pine View Crematory
Address
0 Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z — Removal and/or Held
0, —and/or Address
- Hold
N
0 Date Point of
u) n Transportation Shipment
C by Common Destination
Carrier
ri Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
.* Permit Issued to Registration Number
a Name of Funeral Home Alexander-Baker Funeral Home 00037
i Address
R: 3809 Main Street,Warrensburg,NY 12885
Via.£
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
W.
Permission is hereby granted to dispose of the human r in described al
cove s indicated.
—�
Date Issued _��/0/�`/ Registrar of Vital Statistic i - 1. ,;
(si nature)
District Number Place
. 5660 Warrensburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
z
UW Date of Disposition Mil Place of Disposition gtilnd ,e ,,,,,,
W (address)
N
p0 (section) /� (lot nu ber) (grave number)
Name of Sexton or Person in Charge of Premises 6I t..L 3t vid.
Z (please pent)
W
Signature 4. �- Title COolitieie
(over)
DOH-1555(02/2004)