Loading...
Bennett, Edward NEW YORK STATE DEPARTMENT OF HEALTH 0 't 14 3 7 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Edward David Bennett Male Date of Death Age If Veteran of U.S. Armed Forces, May 9, 2017 73 War or Dates WPlace of Deat . 1 Hospital, Institution or p City, Town o illa South Glens Falls Street Address 47 Harrison Ave., At 305 W Manner of Death X❑ Natural Cause 0 Accident El Homicide 0 Suicide El Undetermined ❑ Pending C.)' Circumstances Investigation W Medical Certifier Name Title W Christopher Hoy MD, Address Hudson Head Waters Queensbury, NY 12804 Death Certific ler� District Number Register Number City, Town oQVilla D 0,A2-h GP-4s eL.0_, ❑Burial Date Cemetery or Crematory May 10, 2017 Pine Vew Crematorium ❑Entombment Address ©Cremation Queensbury,NY 12804 Date Place Removed z ❑ Removal and/or Held and/or Address E Hold CO Date Point of a. 0 Transportation Shipment (i) by Common Destination Ct Carrier Date Cemetery Address ❑ Disinterment ❑ Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom I— Remains are Shipped, If Other than Above M Address C LIJ EL 1 Permission is hereby granted to dispose of the human re a' s describede as indicated. Date Issued 5)1 p / )-7 Registrar of Vital Statistics ' /*°'i (signatu District Number 4-(--5c)ci Place re)(�/� Pa ) ti//* I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 05/10/2017 Place of Disposition Queensbury,NY 12804 2, (address) W (J)' Ce (section) ,J (lot number) (grave number) aCharge of Premises .: ,r,yte — .5,,,„t tr Name of Sexton or Person in z i (p ase print) W Signature 4."t Title tAdvit`t.N_ (over) DOH-1555 (02/2004)