Bennett-Carstens, Joan NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Joan Evelyn Bennett-Carstens Female
Date of Death - Age If Veteran of U.S. Armed Forces,
01/10/2013 60 years War or Dates
Place of Death Hospital, Institution or
City, Tov900)1' /ig X Glens Falls Street Address Glens Falls Hospital
ILI0 Manner of Death Iriu Natural Cause 0 Accident 0 Homicide 0 Suicide 0 Undetermined 0 Pending
W. Circumstances Investigation
ia Medical Certifier Name Title
0 Gary Scidmore Coroner
Address
Chestertown, N Y
Death Certificate Filed District Number Register Number
City, To X t / XX Glens Falls 5601 19
Qii❑Burial Date Cemetery or Crematory
01/14/2013 Pine View Cemetery
❑Entombment Address
NQremation Queensbury, NY 12804
Date Place Removed
Removal and/or Held
and/or Address
F_ Hold
U)
0 Date Point of
Transportation Shipment
C'6 by Common Destination
Carrier
Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
iMiPermit Issued to Registratinn Number
Name of Funeral Home M. B. Kilmer Funeral Home 01077
Address
123 Main Street • N Y 12809
Name of Funeral Firm Making Di osition or to Whom
Remains are Shipped, If Other than Above
Address
CC
ILI
P" Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/14/2013 Registrar of Vital Statistics lx?
sz. "(sign
21 District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
k
Date of Disposition H-14-%3 Place of Disposition -RAIL/ Ckoci„ .
(address)
Ili
CO
C (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises Pro SCittfF
++Z (please print)
Signature Title otzi r}oe
(over)
•
DOH-1555 (02/2004)