Bentley, Christine NEW YORK STATE DEPARTMENT OF HEALTH t .j 5-?
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Christine Marie Bentley Female
Date of Death Age If Veteran of U.S. Armed Forces,
October 18,2011 40 War or Dates No
Place of Death Hospital, Institution or
Z City, Town or Village C/Albany Street Address Albany Medical Center Hospital
iti
in Manner of Death I XI Natural Cause [ I Accident J Homicide Suicide Undetermined Pending
t? Circumstances — Investigation
tu 0 Medical Certifier Name Title
Stephen Lambrihos,MD
Address
AMCH _
Death Certificate Filed District Number Register Number
City, Town or Village City of Albany 0101 1 q f 6
❑Burial Date Cemetery or Crematory
Entombment October 19,2011 Pineview Crematorium
Address
IC Cremation ' Queensbury, New York
Date Place Removed
Z I 'Removal and/or Held
O and/or Address
H Hold
Cl)
O Date Point of
05 I 'Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home,Inc. 01321
Address
.68 Main Street, Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
N Remains are Shipped, If Other than Above
2 Address
re
ilk Permission is he eby granted to dispose of the human remains described above as indicated.
Date Issued /Q g/ oii/ Registrar of Vital Statistics IQ-07-( - 0 . iSia_i
(signature)
District Number 0101 Place City of Albany
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
14.1 Date of Disposition to/total Place of Disposition 49nr4Uli,a Cr 4Or,.....
LLJ (address)
cn
0 (section) c (lot number-- (grave number)
ZName of Sexton or Person in Charge of Premises ` r,,t�/j../- JQMn�
z fit
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Signature AIL /` ,.at Title Cltf n qTO (over)
DOH-1555 (02/2004)