Bezio, Vernal NEW YORK STATE DEPARTMENT OF HEALTH SWVital Records Section r . 1 Burial - Transit Permit
Name First Middle Last Sex
Vernal F. Bezio Male
Date of Death Age If If Veteran of U.S.Armed Forces,
F September 19, 2013 -1�7_1 War or Dates Korean Conflict
Z Place of Death Hospital, Institution or
W City,Town,or Village Whitehall Street Address Residence
0 Manner of Death ITI Natural Cause El Accident ❑Homicide ElSuicide 0 Undetermined ❑ Pending
W Circumstances Investigation
UMedical Certifier Nagle Tile
W Max Grossman ML)
d Address
Whitehall Health Center, Poultney Street Whitehall ,New York 12887
Death Certificate Filed District Number Register Number
City,Town or Village Whitehall 5 .- 5 2 b L — 13
El Burial Date Cemetery or Crematory
September 23, 2013 Pineview Crematorium
❑Entombment Address
E Cremation 21 Quaker Road Queensbury, NY 12804
Date Place Removed
0 ❑Removal and/or Held
and/or Address
I" Hold
0 Date Point of
0 El Transportation Shipment
0. by Common Destination
0 Carrier
Date Cemetery Address
O ❑Disinterment
Reinterment 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
2 Remains are Shipped, If Other than Above
X
W Address
O.
Permission is hereby granted to dispose of the human remains described above a indicated.
Date Issued I )3 Registrar of Vital Statistics t%t, AA,Le•�, ' Li 1f).,�/ --
/ (signature)
District Number 5-7 52, Place Whitehall,New York
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
w Date of Disposition 09/23/2013 Place of Disposition Pineview Crematorium
2 (address)
W
to
0 (section) tot number) (grave number)
0 (�
ZName of Sexton or Person i harge of Pr ises �,,t t+lrtii
W (pl se print)
Signature rly—- Title Clzeillen
(over)
DOH-1555 (02/2004)