Bessett Sr, George : Ni ftq(
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
George ,Tosp h BPssPt-te, Sr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
January 19, 2013 83 yrs. War or Dates 1 946 - 1 947
}- Place of Death Town of Hospital, Institution or Heritage Commons
Z City, Town or Village Ticonderoga Street Address Residential Healthcare
0 Manner of Death �r Natural Cause Accident 0 Homicide Suicide Undetermined Pending
Circumstances Investigation
ui Medical Certifier Name Title
Q Todd R. Waldorf n-0-
Address
1019 Wicker Street, Ticonderoga, New Yo k 12883
Death Certificate Filed Town of District Number Register Number
City, Town or Village Ticonderoga 1 564
❑Burial Date Cemetery or Crematory
QEntombment 1 /22/201 3 Pine View Crematory
Address
s®Cremation Queensbury, New York
Date Place Removed
Z Removal and/or Held
2❑and/or
Address
ti)
Hold
0 Date Point of
CL
Q Transportation Shipment
6 by Common Destination
Carrier
El Disinterment Date Cemetery Address
El Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Wilcox & Regan funeral home 01821
Address
11 Algonkin St. , Ticonderoga, New York 12883
Name of Funeral Firm Making Disposition or to Whom
I Remains are Shipped, If Other than Above
,2 Address
C
111
9' Permission is hereby granted to dispose of the human remains described above as indicated,
Date Issued 1 /2 2/201 3 Registrar of Vital Statistics Q�L c%1 'L_d 711") , aft. ,s_____,
7 (signature)
District Number 1 564 Place Town of Ticonderoga
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
111 Date of Disposition J-1?-t3 Place of Disposition - i.J,J C to,w,'-'
W (address)
to
(section) /� _(lot number(' (grave number)
Name of Sexton or Person in Charge f Premises 6 tiny ,n.4}
// I (please print)
til Si nature �i.,�, Title C 0)
9 Ktl
(over)
DOH-1555 (02/2004)