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Beaty, Donald Herbert NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Donald Herbert Beaty Male Date of Death Age If Veteran of U.S.Armed Forces, 10/31/2023 82 Years War or Dates Korean Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital WW Manner of Death El Natural Cause Accident Homicide OSuicide Undetermined ri Pending Circumstances Investigation 0 Medical Certifier Name Title William Cleaver 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 508 Burial Date Cemetery,Crematory or Facility Name 11/02/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held - Hold Address 0 n- Date Point of U)IDTransportation p by Common Shipment Carrier Destination ElDisinterment Date Cemetery Address OReinterment 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 2 Address W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/01/2023 Registrar of Vital Statistics Megan Train(ECectronicafIySigned) (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: IF- Z Date of Disposition ill3IZ3 Place of Disposition EvGEV tie& 1-re .- LU (address) W CC N (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of mises Z (pl se print) W Signature >.-2Title forA e DOH-1555(07/18)p 1 of 2 e't--t .wr,-, .'% 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#