Bessette, Ernest William o , 6311
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Per it
Bureau of Vital Records
Name First Middle Last Sex
Ernest William Bessette Male
Date of Death Age If Veteran of U.S.Armed Forces,
08/06/2022 75 Years War or Dates
1,,. Place of Death Hospital,Institution or
Z City,Town or Village Hartford Town Street Address 7378 St. Rt.40,Hartford Town,New York 12827
ILI
p Manner of Death ❑X Natural Cause lilAccident El Homicide OSuicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
a Curtis Gedney MD
Address
454 Glen Street,Glens Falls,New York 12801
DeaHth Certificate Filed Town Of Hartford District Number Register Number
City,Town or Village 5759 9
Burial Date Cemetery,Crematory or Facility Name
08/09/2022 Pine View Crematory
Entombment Address
EICremation Queensbury Town,New York
Donation
Q 0 Removal Date Place Removed
and/or and/or Held
i= Hold Address
N
0
d Date Point of
(I) Transportation
p by Common Shipment
Carrier Destination
El
Disinterment
Date Cemetery Address
EReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079
Address
82 Broadway,Fort Edward,New York 12828
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
11, Address
R
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/09/2022 Registrar of Vital Statistics Denise Petteys(ECectronica1CySigned)
(signature/
District Number 5759 Place Town Of Hartford
—
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 9 ill 122, Place of Disposition F..,ty� , r,_
11.1
2 /address/
W
In
CC g (section) / (lot number' (grave number)
Name of Sexton or Person in Charge of Premises f/i ru L . M-t az (pi se print)
Signature s111
Title �j2Fi>»�1 a/e
DOH-i555(07/18)p 1 of 2
•
. rJ
Public Health Law Sec. 4145(2b)
Receipt
Human remains of ;::` <, 5.,, delivered on r, , 20
-
Pine View Cemetery Representing the funeral home named on burial,permit
Official Funeral Directors Reg.or License#