Turcotte, Benoit 12f1542014 Rd:21 5ia5$22A51
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NEW YORK STATE DEPARTMENT OF HEALTH Buda- TransitPermit
Vital Records Section
� Name First Middle -.. Last Sex -
Prf Benoit it Turcotte Male
' Date of Death Age If Veteran of U.S. Armed Forces,
December 8,2014 8 2 War or Dates
Place of Death Hospital, Institution or
City,Town or Village Newcomb `Street Address 5332 State Route 28N
Manner of Death Natural Cause 0 Accident CD Homicide D Suicide El Undetermined Pending
Circumstances Investigation
cuk Medical Certifier Name Title
'atFrank Whitelaw -
�,�' Address
•160 Maple Lane,Bloomingdale,NY 12913
•"" Death Certificate Filed District Number Register Number
fs, City,Town or Village T/O Newcomb --
'':0 Burial Date Cemetery or Crematory
December 15,2014 Pine View Crematory
Entombment
Address
®Cremation 2;1 Quaker Rd., ueensbury,NY 12804 .
,:. Date ' Place Removed
2,ri u Removal and/or Held _____._
' < and/or Address _ -
;- Hold
co.: — —,
;i : Date Point of
la Q Transportation . . Shipment
,ip; by Common Destination
Carrier
Q Disinterment Date Cemetery Address
▪•
•J�Reinterment Date Cemetery Address
, Permit issued to Registration Number
• Name of Funeral Home Alexander-Baker Funeral Home i 00037
,n Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
. ' Remains are Shieped, If Other than Above
1
-
Address r:: Permission is hereby granted to dispose of the human remains described • . •v= : indicated.
: Date Issued !d-/at, 1'1 Registrar of Vital Statistics Il l i!i'..._.�.
` (signature
District Number Place T/O Newcomb
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition J LI I I y Place of Disposition r�I rfid.-
(address)
ta
14 (section) /1 (tot nurrrber) (grave number)
Name of Sexton or Perso 'n Charge of Premises Aii.�ftrt'
•LLT �.-y (p►ease print)
Signature � -- Title Ct ;in
(over)
DOH-1555(02/2004)