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Benjamin, Kathaleen S
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kathaleen S.Benjamin Female Date of Death Age If Veteran of U.S.Armed Forces, 11/16/2021 53 Years War or Dates F.. Place of Death Hospital,Institution or Z City,Town or Village Albany Street Address Albany Medical Center Hospital Manner of Death Undetermined Pendin W ©Natural Cause ElElElAccident Homicide Suicide g U Circumstances Investigation W Medical Certifier Name Title O Amanda Custozzo Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 2839 ElBurial Date Cemetery,Crematory or Facility Name 11/20/2021 Pineview Crematory Entombment Address JCremation Queensbury Town,New York ElDonation 6- CI Removal Date Place Removed and/or and/or Held H N Hold Address 0 O. Date Point of U) ll Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/19/2021 Registrar of Vital Statistics Danielle S Gillespie(Electronically Signed) (signature) District Number 0101 Place Albany, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ZW Date of Disposition //-4i0 air2 t Place of Disposition ,�(> :$4.) 2 (address) W N f CC (section) / (lot'Imbed (grave number) / 0 Name of Sexton or Person in Charge of remises Ay`hDhi Z (please print/ Ti W O 'C/ZS2�' Signatures Title eG DOH-1555(07/18)p 1 of 2 15358 Public Health Law Sec. 4145(2b) Receipt Human remains of ' ' delivered on %' a , Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#