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Beckner, George F. 1/yz� NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex George F.Beckner Male Date of Death Age If Veteran of U.S.Armed Forces, 05/14/2023 90 Years War or Dates Air Force Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address 28 Morgan Avenue,Glens Falls,New York 12801 111 p Manner of Death �Natural Cause Accident1=1 Homicide Suicide Undetermined ❑Pending W Circumstances Investigation WG Medical Certifier Name Title Gerard Abess MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 251 Burial Date Cemetery,Crematory or Facility Name ® 05/16/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation OZ Removal Date Place Removed = and/or and/or Held N Hold Address 0 Ct. Date Point of U)oTransportation by Common Shipment Carrier Destination ODisinterment 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 1— Remains are Shipped,If Other than Above Address W 3' Q. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/16/2023 Registrar of Vital Statistics .:1Megan.NoCrn((Yectronica4r Sand (signature) District Number 5601 Place City Of Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition ,j%J-2p23 Place of Disposition Pt, ��� Crinot f LLI 2 (addrec4 W N CC (section) ,/ (lot n ber) (grave number/ Name of Sexton or Person in Cha Pre is /�ic1/11D 1,1 Z (please print) W Signature Title D f-eS21-4T96--- 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#