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Bennett, Kerri Ann 1 13 Z NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kerri Ann Bennett Female Date of Death Age If Veteran of U.S.Armed Forces, 02/09/2020 30 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Kingsbury Town Street Address 151 Franklin Street, Kingsbury Town, New York 12839 W Manner of Death Undetermined Pending W ©Natural Cause Accident Homicide ❑Suicide Circumstances Investigation W Medical Certifier Name Title Wesley Perry Coroner Address 415 Lower Main Street,Hudson Falls,New York 12839 Death Certificate Filed District Number Register Number City,Town or Village Kingsbury Town 5762 2 Burial Date Cemetery,Crematory or Facility Name 0211012020 Pine View Crematorium Entombment Address x❑Cremation Town of Queensbury,New York Donation 0 Removal Date Place Removed and/or and/or Held F-N Hold Address O d Date Point of N ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition orto Whom - Remains are Shipped,If Other than Above Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/10/2020 Registrar of Vital Statistics CyntkiaA Bardin(ECectronicallySigned) (signature) District Number 5762 Place Kingsbury Town, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H Z Date of Disposition Z ltl I to Place of Disposition 1 �71tda LU (address) W N (section) (lot number/ (grave number) M G Name of Sexton or Person in Charge of Pr mises r' /p ase print/ W Signature 4 Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 013327 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#