Benoit, Joseph NEW YORK STATE DEPARTMENT OF HEALTHY 1 SS
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
, Joseph David Benoit male
• Date of Death Age If Veteran of U.S. Armed Forces,
June 2, 2014 67 War or Dates 1964-66
Place of Death Hospital, Institution or
W GiityxTown az3iiklagec Minerva Street Address 1 25 Northwoods Club Rd
CI Manner of Death 0 Natural Cause n Accident 0 Homicide ID Suicide Undetermined El Pending
Circumstances Investigation
11 Medical Certifier Name Title
CI
. Elaine Williams ANP
Address
�,-' 325 Main St. Hudson Falls, NY
Death Certificate Filed District Number Register Number
, Town ox Vilimexx Minerva
'.❑Burial Date Cemetery or Crematory
June 4, 2014 Pine View Crematorium
• 0 Entombment Address
• lremation Tn of Queensbury, NY
' Date Place Removed
Removal and/or Held
I I
and/or Address
p Hold •
10
Date Point of
, Transportation Shipment
4 by Common Destination
p Carrier
, l Disinterment Date Cemetery Address
EiReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc.
Address
P.O. Box 67, 68 Main St. , Hudson Falls, NY 12839
, Name of Funeral Firm Making Disposition or to Whom
j- Remains are Shipped, If Other than Above
2 Address
W
140
Permission is hereby granted to dispose of the human ains described above as indicated.
Date Issued L-3- 1 I I Registrar of Vital Statistics
(signature)
• District Number '6��1 Place ` -0 �Ln_e--v D7
'., I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
,W Date of Disposition fo/N/�r1 Place of Disposition 't�nLV'" ( rkf
vfortu--
(address)
la
IE (section) At,
numb (grave number)
0 Name of Sexton or Perso in Charge of Premises �'""''I as- _cam
z; (pl e print)
UI Signature Title r~ofe
(over)
DOH-1555(02/2004)