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Bennett, Ruth NEW YORK STATE DEPARTMENT OF HEALTH It,'c- Vital Records Section Burial - Transit Permit tl, Name First Middle Last Sex Ruth Emily Bennett Male Date of Death Age If Veteran of U.S. Armed Forces, January 19, 2011 68 War or Dates Place of Death Hospital, Institution or Fi City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death m E.i Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ] Undetermined ❑ Pending Circumstances Investigation iii'l Medical Certifier Name Title Darci Gaioth-Grubbs, Dr. rt `,i Address 102 Park Street Glens Falls, NY 12801 ® Death Certificate Filed District Number .—v, 0 r Registeruter City, Town or Village , ❑Burial Date Cemetery or Crematory January 21, 2011 Pine View Crematorium 54t❑Entombment Address y.-1.- ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed ❑ Removal and/or Held and/or Address Hold Date Point of ❑Transportation Shipment by Common Destination -0 Carrier wt Date Cemetery Address ❑ Disinterment ❑ Reinterment Date Cemetery Address ` Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00276 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission i hht reb granted to dispose of the human mains scribed a ove as in cated. 4 Date Issued �)( �(� j/ Registrar of Vital Statistics C%�'_ '-- ',- � 0 (signature District Number 5706( Place ..... --j l /s�--�_.-g—! , ; I certify that the remains of the decedent identified above ere disposed of in accordance w. this permit on: ,' Date of Disposition=-11106)2611 Place of Disposition 4L i wt3.J LN'u4«tDr;4— . (address) I (section) (lot num ) (grave number) `, Name of Sexton or Pe son in Charg of Premises 4 F=3'�a it r -�Q°114 (please print) t€ , Signature Title CVC rn 4Z01- (over) DOH-1555 (02/2004)