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Bennett, Dorothy L. � 11 NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last t�ale Dorothy L Bennett Date of Death Age If Veteran of U.S.Armed Forces, 01/26/2020 74 Years War or Dates II.— Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address The Stanton Nursing And Rehabilitation Centre pMannerof Death ©Natural Cause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title Wendy Steinhacker PA Address 152 Sherman Ave,Queensbury Town,New York 12801 Death Certificate Filed District Number Register Number City,Town or Villa a Queensbury 5657 13 Burial Date Cemetery,Crematory or Facility Name 01/28/2020 Pine View Crematory Entombment Address MV IX 1 Cremation Queensbury Town,New York Donation Z Removal Date Place Removed and/or and/or Held NHold Address dDate Point of to Transportation Shipment jS by Common Carrier Destination Ej Disinterment Date Cemetery Address Date Cemetery Address Reinterment Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom IH Remains are Shipped,If Other than Above Address Q W 0. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/28/2020 Registrar of Vital Statistics Caroline xCtfegarde Barber(ECectronicalTy Signed (signature! District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition 30 110 Place of Disposition &1,0 Ill (address) 2 W U) (section) (/otnumbT"t . (grave number) 8O Name of Sexton or Person in Charge of Premises 14 Z (Pkase print/ W Signature Title DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) 013290 Receipt Human remains of �� a��t -� j 1�' 1- ! t _` delivered on , 20 Pine View Cemetery Representing the funeral home named op bu ' eax ut Official Funeral Directors Reg.or License# ' '