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Benassi, Ruth NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Ruth Anne Benassi Female Date of Death Age If Veteran of U.S.Armed Forces, 10/31/2019 89 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc ,p Manner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending U Circumstances Investigation QMedical Certifier Name Title Michael Miles MD Address 319 Broadway,Fort Edward Town, New York 12828 Death Certificate Filed District Number 71egivter Number City,Town or Village Fort Edward 5755 ❑Burial Date Cemetery,Crematory or Facility Name El Entombment 11/01/2019 Pine View Crematory Address FECremation Queensbury Town,New York ❑Donation Z Date Place Removed Q ❑Removal and/or and/or Held Hold Address Q iL Date Point of CO) ❑Transportation p by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward, New York 12828 Name of Funeral Firm Making Disposition or to Whom I Remains are Shipped,If Other than Above 2 Address M W (L Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/01/2019 Registrar of Vital Statistics 4imeeMahoney(E(ectronicaCCySigned) (signature) District Number 5755 Place Fort Edward, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: LLZl Date of Disposition jfj$"I Place of Disposition 2 (address) W M (section) ' (lot number (grave number) a Name of Sexton or Person in Charge of Premises Al LA- Z please print) W Signature Title DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) ~' Q 31-3 0 4 4 Receipt Human remains of �. •'' `' -r.>% ' delivered on 1''f'�/ ! , 20 Pine View Ciemetery Representing the funeral home named on buriermit Official Funeral Directors Reg.or License# ��