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Beedenbender, Adam t__ ...4... , 9.3y NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Adam Beedenbender Male Date of Death Age If Veteran of U.S.Armed Forces, 11/18/2023 77 Years War or Dates 1966-69 F. Place of Death Hospital,Institution or WCity,Town or Village Horicon Town Street Address 14 Harris Road,Horicon Town,New York 12815 p Manner of Death El Natural Cause Accident Homicide Suicide OUndetermined ❑Pending tL Circumstances Investigation W Medical Certifier Name Title G Lynn Keil PA Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Horicon District Number Register Number City,Town or Village 5654 9 Burial Date Cemetery,Crematory or Facility Name 11/21/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held F- Hold Address CO 0 a Date Point of CO❑Transportation CI Common Shipment Carrier Destination Date Cemetery Address Disinterment Date Cemetery Address n Reinterment Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above 5 Address IX W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/21/2023 Registrar of Vital Statistics 7Crista£ Wood"(ECectronicaCCySigned) (signature) District Number 5654 Place Town Of Horicon I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition /i tr--I1Jz 3 Place of Disposition t,1 i e Vi`e. e /1?et"Cio/'- 2 (address) W U IX (section) (ot number) (grave number) 8 Name of Sexton or Person in Charge of Premi KafrV,✓� l Md z 11 (please print) W Signature 7-J d// % Title o 4� ls;` : U DOH-1555(07/18)p 1 of 2 � � . �.:, ..,� Public Health Law Sec. 4145(2b) a ems 4 Receipt Human remains of ` ' : delivered on 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#