Beadnell, John G ict Fpoc
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
John G.Beadnell Male
r Date of Death Age If Veteran of U.S.Armed Forces,
05/12/2022 81 Years War or Dates
t Place of Death Hospital,Institution or
WCity,Town or Village Warrensburg Town Street Address 44 James Street,Warrensburg Town,New York 12885
10 11
Manner of Death ❑X Natural Cause riAccident Homicide Suicide Undetermined Pending
Circumstances Investigation
I Medical Certifier Name Title
0 Patricia Stevenson PA
Address
9 Carey Road,Queensbury Town,New York 12804
DeaRth Certificate Filed Town Of Warrensburg District Number Register Number
City,Town or Village 5660 9
Burial Date Cemetery,Crematory or Facility Name
05/16/2022 Pine View Crematory
Entombment Address
MCremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
i- Hold Address
N
0
CL Date Point of
CO OTransportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
❑Reinterment
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
1-: Remains are Shipped,If Other than Above
g Address
C
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/16/2022 Registrar of Vital Statistics Pamela 9l4 LCoye(Efectronica1TySigned)
(signature)
District Number 5660 Place Town Of Warrensburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
~ ?L VL__ 6"----..-
Z Date of Disposition �f 1�� 2Z Place of Disposition �
W
(address)
W
CCCC (section) A (lot
number) (grave number)
C Name of Sexton or Person in Charge f Premises /��4ase`- 4(1$
print)
CU
Signature Title 6
DOH-1555(07/i8)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
•
Human remains of •• delivered on , 20
Pine View Cemetery Representing the funeral home named gn buri4.permit
Official Funeral Directors Reg.or License#