Bessey, Paul A lIzo
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Paul A Bessey Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/06/2022 53 Years War or Dates
Place of Death Hospital,Institution or
LU
Z City,Town or Village Schroon Town Street Address 2424 U.S.9 Route,Schroon Town,New York 12870
p Manner of Death 0 Natural Cause DI Accident Homicide Ei Suicide Undetermined Pending
0 C.) Circumstances Investigation
Medical Certifier Name Title
Kellie Valentine Coroner
Address
PO Box 132,Elizabethtown Town,New York 12932
Death Certificate Filed District Number Register Number
City,Town or Village Schroon Lake 1563 2
Burial Date Cemetery,Crematory or Facility Name
02/09/2022 Pine View Crematory
❑Entombment Address
0 Cremation Queensbury Town,New York
ElDonation
8 Removal Date Place Removed
E and/or and/or Held
N Hold Address
0
a Date Point of
U) Li Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Edward L Kelly Funeral Home 00519
Address
PO Box 548,Schroon Lake,New York 12870
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped,If Other than Above
2 Address
CC
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/08/2022 Registrar of Vital Statistics Patricia Savarie gkaronicaIry SOnet9
(signature)
District Number 1563 Place Schroon Lake, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
E—
Z Date of Disposition a.-- Place of Disposition 1/n' V�(J u) C cc./Av Y
UJ
2 (address)
Ui
r)
CC (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises J e E/rtiG � V j`G 5
/ (please print
W Signature -.61A.4 / Title cre.,scInr
DOH-1555(07/18)p t of 2 /
Public Health Law Sec. 4145(2b) r.
Receipt
1
1
1 Human remains of delivered on , 20
1
1
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#