Bennett, MarionNEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records
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Burial - Transit Permit
Name First Middle Last
Sex
Marion Sylvia Bennett
I Female
Date of Death
Age
If Veteran of U.S. Armed Forces,
10/04/2019
88 Years
War or Dates
II.-
Place of Death
Hospital, Institution or
WCity,
Town or Village Glens Falls
Street Address Glens Falls Hospital
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Manner of Death RX Natural Cause Accident Homicide Suicide Undetermined Pending
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Circumstances Investigation
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Medical Certifier Name Title
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Stephen Perazzelli MD
Address
100 Park St, Glens Falls, New York 12801
Death Certificate Filed
District Number
Register Number
City, Town or Village Glens Falls
5601
431
Burial
Date Cemetery, Crematory or Facility Name
Entombment
10/08/2019 Pine View Crematory
Address
Cremation
Queensbury Town, New York
Donation
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Removal
Date
Place Removed
and/or Held
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and/or
Hold
Address
N
O
n.
Date
Point of
N
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❑Transportation
by Common
Shipment
Carrier
Destination
Disinterment
Date
Cemetery Address
Reinterment
Date
Cemetery Address
Permit Issued to
Registration Number
Name of Funeral Home Maynard D Baker Funeral Home
01130
Address
11 Lafayette St, Queensbury, New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
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$
Permission is hereby granted to dispose of the human remains described above as indicated.
.Date Issued 10/08/2019 Registrar of Vital Statistics 06-rAidrewCurnt (Ekctro-ka-ySozed)
(signature/
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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Place of Disposition � lj Of rv*.—
Date of Disposition �0 P
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(address)
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N
(section) (lot number/ (grave number/
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SName
of Sexton or Person in Charge of Premises "'t
(please print
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Signature Title
DO H-1555 (o7/18) p 1 of 2
Public Health Law Sec. 4145(2b)
012586
Receipt
Human remains of f f 2, s e delivered on , 20 12
Pine View Cemetery Representing the funeral home named pn burial permit
Official Funeral Directors Reg. or License 1 ` ` s