Loading...
Brown, Beverley ict NEW YORK STATE DEPARTMENT OF HEALTH ` , } S J ' Vital Records Section . Burial - Transit Permit Name First Middle Last Sex : Y Beverle A. Brown Female g Date of Death Age If Veteran of U.S.Armed Forces, SISeptember 21,2013 85 War or Dates ' ��'Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death Natural Cause n Accident Homicide I I Suicide I I Undetermined Pending Circumstances Investigation_ Medical Certifier Name Title David Cunningham,MD Address I% Glens Falls,NY ;F Death Certificate Filed District Number Regi5t r qmber ge City, Town or Village Glens Falls,NY 5601 c3 0 Burial Date Cemetery or Crematory El Entombment September 23,2013 Pine View Crematorium Address ©Cremation 21 Quaker Road, Queensbury,NY 12804 Date Place Removed Z 0 Removal and/or Held and/or Address H Hold 0 Date Point of aSE Transportation Shipment a by Common Destination Carrier Disinterment Date Cemetery Address n Reinterment Date Cemetery Address r Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 of Address f 53 Quaker Road, Queensbury,NY 12804 ftA Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above WI Permission is hereb granted to dispose of the human remains d crib d v Ca dicated. ` r J .�� Date Issued .23 3 Registrar of Vital Statistics ti .X (signature) r . t District Number 5601 Place Glens Falls,NY I certify that the remains of the decedent identified above were disposed of in accordanceI'' with this permit on: LuDate of Disposition ¶(t31c, Place of Disposition 4,,Vuu Cori.,_. W (address) N fY (section) (lot numb' (grave number) p Name of Sexton or Person in Char of Premises c, ,. ..Nluitt Z (please print) W Signature A— Title 01Rov ti dt (over) DOH-1555(02/2004)