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Beckwith, Ryan A
NEW YORK STATE DEPARTMENT OF HEALTH101:5 Burial- Transit Permit oo Bureau of Vital Records Name First Middle Last Sex Ryan A Beckwith Male Date of Death Age If Veteran of U.S.Armed Forces, 11/05/2023 52 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 ❑X Natural Cause IllAccident ❑Homicide Duicide FlUndetermined Pending W Circumstances Investigation W Medical Certifier Name Title ID Christopher Smith MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 519 Burial Date Cemetery,Crematory or Facility Name 11/07/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York DDonation ZO❑Removal Date Place Removed and/or and/or Held NHold Address 0 d Date Point of U)❑Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address 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 1— Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/07/2023 Registrar of Vital Statistics Megan No(in(E(ectronicafy 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 11 (g I Z3 Place of Disposition �1iJ f tl te6 MA70Qrvh 2 (address) W (sedan) it (lot number) (grave number) SName of Sexton or Person in Charge of remises — S hit I1 Z (p/ese print) W Signature Title C 'm.4-�r DOH-1555(07/18)p 1 of 2 YHk 4 6 Public Health Law Sec. 4145(2b) 0 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#