King, Beecher NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Beecher A K1.ng :..:..:.....:. .::. .Male.:::::::::.._.
............ ...... _ ...
Date of Death Age If Veteran of U.S.Armed Forces,
2/5/95 �71 War or Dates WWII
!-� .:. _:.....::: ........ ........
Place of Death Hospital, Institution or
C TownnxCMjgVgt Inrlzan Lake Street Address Rt 3.Q,...Box:.,7:0.10_...._::
....................
::.
W Manner of Death Natural Cause1:1 Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
.... ................ ...::.
..... ... .... ... .....: ...
Medical Certifier Name Title
p Robert W. Sponzo M.D.
......:... .:::..... ....:...... ... . .....:.... ........... .-................ _.
Address
100 Park St. Glens Falls, NY 12801
... . ....... _ ....
..................
Death Certificate Filed District Number Register Number
Cfc,Town(xxVANe Indian Lake 2053
Date Cemetery or Crematory
El Burial 2/6/95 Pine View Crematory
.......: : ,::,::.. .: ::::::......::.__ . ...... .. .........
Cremation Address
Queensbury, NY
. __
Z Date Place Removed
O"`, Removal and/or Held
F-' and/or Hold _::....... ... ::::.: .:::..... ........:.
Address
CL Date Point of
cn, []Transportation by Shipment
p' Common Carrier .......................................... ..:::.. ................................... ..
Destion
❑ Disinterment Date Cemetery Address
❑ Reinterment : Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Firm Brewer Funeral Home, Inc. _ :: _......0:0.223:.::....
...... . - -
Address
P 0. Box 500 . Lake Luzerne,_ NY_::_,1:2846.: :..... ._ .. .,_................
#—I Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
M. Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 9/F, 9 Registrar of Vital Statistics,
(signature)
District Number p30 S3 Place Indian. r ali e, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition Place of Disposition
2;. (address)
ul
W` (section) (lot number) (grave number)
cc
p' Name of Sexton jpr Person in Charge of Pr ises
Z4"
(please print) i7
W'' Signature '"'� Title C
DOH-1555 (10/89) p. 1 of 2 VS-61