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Biddiscombe, Charles Chadwick
it gZO NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Charles Chadwick Biddiscombe Male Date of Death Age If Veteran of U.S.Armed Forces, 09/24/2021 81 Years War or Dates Army F, Place of Death Hospital,tnstitution or Z City,Town or Village Queensbury Town Street Address 215-1 Robert Gardens North,Queensbury Town,New York 12804 IW Undetermined Pending W Manner of Death © Natural Cause Accident Homicide Suicide Circumstances Investigation W Medical Certifier Name Title 0 John Sawyer MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 198 Burial Date Cemetery,Crematory or Facility Name 09/27/2021 Pine View Crematory ❑Entombment Address lCremation Queensbury,New York ElDonation Z Removal Date Place Removed and/or and/or Held H Hold Address N 0 O. Date Point of co Li Transportation S by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom F Remains are Shipped,If Other than Above a Address Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/27/2021 Registrar of Vital Statistics Caroline x/fegarde Barber(ECectronica1Ty Signed) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F /7 W (ZYI Date of Disposition � l� Place of Disposition ,�E.��... ..�d€�-- 2 (address) W NOC (section) I 1 (iot numbers (grave number) 0 Name of Sexton or Person in Charge of Pre isest`i �" �"+^441 � (pa se print) IU TheSignature L:./' Title '''' ``Z DOH-1555(07/18)p 1 of 2 • ,.z 0 C.. 5 7r'S.l A Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#