Loading...
Theis, Beverly Helen NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Beverly Helen Theis Female Date of Death Age If Veteran of U.S.Armed Forces, 02/04/2024 91 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc p Manner of Death Z Natural Cause Accident Homicide Suicide Undetermined Pending U Circumstances Investigation W Medical Certifier Name Title CI Rick Teetz MD Address 131 Lawrence St,Saratoga Springs,New York 12866 Death Certificate Filed City Of Saratoga Springs District Number Register Number City,Town or Village 4501 77 Burial Date Cemetery,Crematory or Facility Name 02/06/2024 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation OZ❑Removal Date Place Removed and/or and/or Held H N Hold Address 0 O. Date Point of U)❑Transportation Q by Common Shipment Carrier Destination EIDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above Address CC W EL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/05/2024 Registrar of Vital Statistics Etilfon Moran(ECectronicalySigned) (signature) District Number 4501 Place City Of Saratoga Springs I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: l� r��� Date of Disposition 21¶t Z' Place of Disposition ��E✓ ✓ OP,- � l'-- - 2 (address) W CC CC (section) I (lot number) (grave number) 0 Name of Sexton or Person in Charge• ' .es t' �- in (p ase print) t W Title (ram '�:Z Signature DOH-1555(o7/18)p t of 2 Y, 7 ,� h+.' 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#