Bennett, Carolee NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Carolee Elma Bennett Female
Date of Death Age If Veteran of U.S. Armed Forces,
3/31/20117 86 yaArc War or Dates
t Place o Death Hospital, Institution or
W City, T e Street Address
X}� Cohoes 1i3 Remsen St, cohoea
W Manner o ea 1 Natural Cause ❑Accident ❑Homicide ❑Suicide ❑ undetermined ❑Pending
V Circumstances Investigation
u.i Medical Certifier Name Title
G
dh-rtc s Smoot Coroner
112 State Street, Albany, N Y
Death Certificate Filed District Number Register Number
City,awii¶1e Cchoog 1 n2 ag
❑Burial Date Cemetery or Crematory
❑Entombment 04/07/20 ? Pine View Crematory
Address
]Cremation O„ppnchury, NY
Date Place Removed
Z Removal and/or Held
2 ❑and/or
� Address
Hold
tO
0 Date Point of
(95 ❑Transportation Shipment
O by Common Destination
Carrier
El Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M b. Kilmer Funeral Home 01079
Address
82 Broadway Fort Edward .N `r' 12828
Name of Funeral hirm Making Disposition or to Whom
Remains are Shipped, If Other than Above
a Address
fi
W
Permission is hereby granted to dispose of the human rem ins c 'bed ab a as i dica d.
Date Issued 04/03/2017 Registrar of Vital Statistics G / /�-'`.
(si n ture)
i
District Number Place
102 Cohoes
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W w Date of Disposition y- "1-1 Place of Disposition -fLkle,.' l;r-viti.0 -
W (address)
1
re (section) (lot number) (grave number)
pName of Sexton or Person in Char, e of Premises /1rjr �omilt
Z //� (p ease print)
Signature ' Title �j'�`m (�f
(over)
DOH-1555 (02/2004)