Beckerle, Peter Richard (2) 41
NEW YORKSTATE DEPARTMENTOFHEALTH � S�
Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Peter Richard Bedcede Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/10/2022 67 Years Waror Dates
Ir Place of Death Hospital,Institution or
Z City,Town or Village Lake Luzeme Town Street Address 1636 Call Street,Lake Luzeme Town,New Yoh 12846
Man nerof Death a Natural Cause ❑Accident Homicide ❑Suicide Undetermined Pending
WO
0 Circumstances Investigation
C
Medical Certifier Name Title
Suzanne Blood MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of take wises District Number Register Number
ECit ,Town or ViUaje 5656 13
Burial Date Cemetery,Crematory or Facility Name
07/12/2022 Pine View Crematory
Entombment Address
pCremation Queensbury Town,New York
DDonation
Removal Date Place Removed
and/or and/or Held
as Hold Address
00 ransportation Date Point of
by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Date Cemetery Address
IDReinterment
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
}. Remains are Shipped,If Other than Above
2 Address
Q
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/12/2022 Registrar of Vital Statistics Cywt,Fi4SAs1v of ce *S,w,d)
(signature)
District Number 5656 Place Town Of Lake Luzeme
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition )J(0121_ 1 t Place of Disposition ` IL s (=—___
X (ad*ess/
W
CO
8 (section)
blot number) .��'r''►�'i (grew number)Name of Sexton or Person in Chang Premises dvi'lli
SZII ease print/ n �,s
Signature Title G rt"1 w I O‹
DOH 1555(07/18)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 on burial permit
Official Funeral Directors Reg.or License#