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Benway, Catherine NEW YORK STATE DEPARTMENT OF HEALTH P �'5 . Vital Records Section E Burial - Transit Permit Name First Middle Last Sex Catherine Anne Benway Female Date of Death Age If Veteran of U.S. Armed Forces, November 3, 2017 65 War or Dates Place of Death Hospital, Institution or W City, Town or Village Kingsbury Street Address 34 Division Street LI W Manner of Death Natural Cause El Accident ❑ Homicide El Suicide ❑ Undetermined El❑ Pending U. Circumstances Investigation W Medical Certifier Name Title Ci Ageel Gillani, M.D. Dr. Address 100 Park Street, Pryne Pavillian Glens Falls, NY 12801 Death Certificate Filed District Number Register Number City, Town or Village S'7 6, a ) •7 ❑Burial Date Cemetery or Crematory Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z ❑ Removal and/or Held and/or Address F. Hold Pine View Crematorium CO Date Point of ,, , ❑Transportation Shipment C/) by Common Destination Ci Carrier Date Cemetery Address ❑ Disinterment Date Cemetery Address ❑ Reinterment 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 1- Remains are Shipped, If Other than Above M Address W ty.. Permission is hereby granted to dispose of the human remain escribed above as indicated. Date Issued 11-'r U !7 Registrar of Vital Statistics C p (signature) District Number /7 C c Place ) ,.(:,); ,`, I certify that the remains of the decedent identified ove were dispo ed of in accordance with this permit on: I— W'' Date of Disposition io n i f Place of Disposition Quaker Road Queensbury,NY 12804 2 (address) WCO (section) /I (lot number) (grave number) CO p Name of Sexton or Person in Charge of Pre ises L L ,,hit___,. ,S-t...."..471 z (Obese print) n W Signature '� ,-r Title CAA A)Pi NY (over) DOH-1555 (02/2004)