Beswick, Lillian Amelia if 3 W
NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit
Bureau of Vital Records • -'
Name First Middle Last Sex
Lillian Amelia Beswick Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/30/2021 99 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc
W
p Manner of Death ❑X Natural Cause Accident Homicide Suicide 0 Undetermined ❑Pending
C.) Circumstances Investigation
W Medical Certifier Name Title
Carrie Miron PA
Address
319 Broadway,Fort Edward Town,New York 12828
Death Certificate Filed District Number Register Number
City,Town or Village Fort Edward 5755 20
Burial Date Cemetery,Crematory or Facility Name
04/01/2021 Pine View Crematory
❑Entombment Address
0 Cremation Queensbury Town,New York
❑Donation
Removal Date Place Removed
and/or and/or Held
F Hold Address
0
a Date Point of
en Li Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
Reinterment
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/01/2021 Registrar of Vital Statistics AmeeLglalroney(TectronicallySigned)
(signature)
District Number 5755 Place Fort Edward, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition �ZZ� Place of Disposition �,���
(address)
W
CC
N (section) (l umber) (grave number)
0 Name of Sexton or Person in Charge of Premises /1 a k- 4444,40
(please t)
W Signature Title `Po2
DOH-1555(07/18)p i of 2
Public Health Law Sec. 4145(2b) 014668
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#