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Beck, Brian Donise
NEW YORK STATE DEPARTMENT OF HEALTH ._ _ Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Brian Donise Beck Male Date of Death Age If Veteran of U.S.Armed Forces, 10/05/2023 50 Years War or Dates .., Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death a Natural Cause Accident 0 Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title o David Cunningham 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 462 Burial Date Cemetery,Crematory or Facility Name 10/06/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held H Hold Address CO 0 a. Date Point of M❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address OReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 2 Address Q W a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/06/2023 Registrar of Vital Statistics Megan Wbli'n(E(ectronically Signed) (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 / W Date of Disposition /p/�Zl Z Place of Disposition g',,,(r, 1/,`�„� L��'�Mrcr ,+� 2 (address) W Cl)CC (section) (lot number), (grave number) 8 Name of Sexton or Person in Charge of P mmises /) -R 4 i-ipV/) tilts z / / '/ i (please print) W Signature lf. li✓ii Title G'fly�6U� DOH-1555(07/18)p 1 of 2 I • 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#