Bederian, Joseph q ()
NEW YORK STATE DEPARTMENT OF HEALTH I
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Joseph H. Bederian Male
Date of Death Age If Veteran of U.S. Armed Forces,
July 20,2013 27 War or Dates
},,. Place of Death Hospital, Institution or
X City, Town or Village Queensbruy Street Address 15 Pine Comb Drive
a Manner of Death ❑Natural Cause ❑Accident ❑Homicide ❑X Suicide 1-1 Undetermined n Pending
111 Circumstances Investigation
4.3
Medical Certifier Name Title
0 Gary Scidmore Coroner
Address
1340 St.Route 9,Lake George,NY 12845
Death Certificate Filed Qi.strict Number pegister Number
City, Town or Village Queensbury CA-- 0
❑Burial Date Cemetery or Crematory
July 22,2013 Pine View Crematory
❑Entombment Address
®Cremation Quaker Road, Queeensbury, NY 12804
Date Place Removed
Z Removal and/or Held
2 and/or Address
H Hold
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0 Date Point of
y ❑Transportation Shipment
p by Common Destination
Carrier
El Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
1- Remains are Shipped, If Other than Above
2 Address
CL
W
O. Permission is eereby' granted to dispose of the human remains described a ve as indicated.
Date Issued "I ` Registrar of Vital Statistics C ._0(
(signature)
)
District Numbers -1 Place Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
w Date of Disposition 1-22-177 Place of Disposition PozDeu4 rc"vcf0;+t•,
2 (address)
co
W 1(lotruirilLer)
re (section) S' (grave number)
pName of Sexton or Person in harge of Premi es J� erwr'l-
Z (plea print)
W Title C1/J !0
Signature _
(over)
DOH-1555(02/2004)