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Bennett, Daniel NEW PORK STATE DEPARTMENT OF H Burial - Transit Permit First 1d Vital Records Section dle' Last Sex Daniel Harry Bennett Male >: Date of Death Age If Veteran of U.S. Armed Forces, December 28, 2017 77 War or Dates 1960 - 1964 Place of Death Hospital, Institution or City, Town or Village Albany Street Address Albany Medical Center Hospital ii4Manner of Death L Natural Cause E Accident 0 Homicide E Suicide nUndetermined Q Pending 111 Circumstances Investigation Ea jib Medical Certifier Name Title 7 Donald Tessitore, NP [e. Address ;'. 43 New Scotland Avenue, Albany, NY 12208 "< Death Certificate Filed District Number Register Number City, Town or Village Albany 4 N. 101 z,q i / OBurial Date — Cemetery or Crematory '?i--: rnbment January 2, 2017 Pine View Crematorium _ Address ©Cremation Town oeensbur , NY Date Place Removed Removal and/or Held and/or Address Hold Alt Date Point of ❑Transportation Shipment _ a by Common , Dest°' ation Carrier . 1' Disinterment Date Cemetery Address '` Date ' Cemetery Address 0 :L Reinterrnent y::i- Permit Issued to Registration Number Name of.Funeral Home Carleton Funeral Home, Inc. 00281 _ ? ; Address PO Box 67, Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other tharrAbove M Address t Permission is hereby granted to dispose of the human remains above as indicated. ig i ; Date lssued 12/z 7/i 7 Registrar of Vital Statistics f (signature) 1. District Number 610 I Place C. 1' d - i Iixt vi\, RR 41 I certify that the remains of the decedent identified above were disposed of in ac ordance with this permit on: :III Date of Disposition E 13I► Place of Disposition U , 'c—_i 11.1 (address) tA (section) /� (lot number) (grave number) tl Name of Sexton or Person in Charge of emises l{r�� `',ktr /l (lease print) Signature U Title /PiG E`T/e (over) DOH-1555 (02/2004)