Bennett, Luman NEV4YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Luman Bennett Male
Date of Death Age If Veteran of U.S. Armed Forces,
f- July 14, 2006 65 War or Dates
2 Place of Death Hospital, Institution or
W City, Town, or Village Glens Falls Street AddressGlens Falls Hospital
0 Manner of Death x❑ Natural Cause ❑ Accident ❑ Homicide Suicide ❑ Undetermined ❑ Pending
W Circumstances Investigation
() Medical Certifier Name Title
W ROBERT W SPONZO MD
a Address
102 Park St., Glens Falls, NY 12801
Death Certificate Filed District Number / Register Number
City, Town or Village Glens Falls 3 4/4'
Date Cemetery or Crematory
❑x Burial July 18, 2006 PINE VIEW CEMETERY
Address
❑Cremation
Tn of Oueensburv, NY
Date Place Removed
0 0 Removal and/or Held
- and/or Address
Hold
0 Date Point of
0 ❑Transportation Shipment
d by Common Destination
di Carrier
Date Cemetery Address
a ❑ Disinterment
❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00284
Address
F 68 Main St., P. O. Box 67, Hudson Falls, New York 12839
Name of Funeral Firm Making Disposition or to Whom
ix Remains are Shipped, If Other than Above
W Address
C.
Permission is hereby gran ed to dispose of the human remains described above ass'ndic d.
Date Issued O�%2,2 Registrar of Vital Statistics ,€ JL% .,
(signature)
District Number 3 O/ Place Glens Falls,New York
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
wDate of Disposition 7/18/06 Place of Disposition PINE VIEW CEMETERY,QUEENSBURY NY
W (address)
NEIDA 32-B 1
yr
Ix (section) (lot number) (grave number)
0
C Name of Sexton or Person in Charge of Premises M I CHAEL GEN I ER
W % (please print)
Signature .+ Title SUPT.