Bent, Mary }
NEW YORK STATE DEPARTMENT OF HEALTH / / /
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Mary Bent Female
Date of Death Age If Veteran of U.S. Armed Forces,
02 / 08 / 2017 82 War or Dates
i', Place of Death Hospital, Institution or
WCity, Town or Village Glens Falls Street Address Glens Falls Hospital
0 Manner of Death r Natural Cause 0 Accident ❑Homicide O Suicide 7 Undetermined —Pending
Circumstances —Investigation
{yj Medical Certifier Name Title
Q Dean Reali DO
Address
100 Broad St # 2, Glens Falls, NY 12801
Death Certificate Filed District Number Register_ umber
City, Town or Village Glens Falls L5 di
!<' OBurial Date Cemetery or Crematory
02 / 10 / 2017 Pine View Crematory
iMi Entombment Address
iii ECremation Queensbury, NY
Date Place Removed
Removal and/or Held
2, and/or Address
t Hold
0 Date Point of
Q'
c Transportation Shipment
. by Common Destination
Carrier
Aiii s!? Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
g Address
402 Maple Ave. , Saratoga Sp. , NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
ir
III
P Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued / r C� ( i 7 Registrar of Vital Statistics L�e k..A .,,,w �
Z
(signature)
District Number 5 C,Q i Place Glens Falls , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
;Z "
W Date of Disposition 1)3 I 1-1 Place of Disposition 'Gci 0,Sr ti'"hq` ar,vA-1
12 (address)
to
Q (section) plot number) (grave number)
pName of Sexton or Person in Charge.of Premises ` illy-,ly-, ,J i't t
t� (pl�ase print) •
Signature Title 174 w1 `ticl
(over)
DOH-1555 (02/2004)