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DiBenedetto, Christopher A
• NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Christopher A.DiBenedetto Male Date of Death Age If Veteran of U.S.Armed Forces, 12/21/2021 61 Years WarorDates Place of Death Hospital,Institution or W City,Town or Village South Glens Falls Village Street Address 29 First Street 7,South Glens Falls Village,New York 12803 p Manner of Death ©Natural Cause Accident Homicide Suicide El Undetermined Pending 0 Circumstances Investigation WG Medical Certifier Name Title David DeCelle Coroner Address 40 McMaster Street,Ballston Spa,New York 12020 Death Certificate Filed District Number Register Number City,Town or Village South Glens Falls Village 4524 27 Burial Date Cemetery,Crematory or Facility Name 12/27/2021 Pine View Crematorium El Entombment Address • 0 Cremation Queensbury Hamlet,New York Donation Removal Date Place Removed H and/or and/or Held N Hold Address 0 0. Date Point of co❑Transportation p by Common Shipment Carrier Destination ElDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom F— Remains are Shipped,If Other than Above 2 Address W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/27/2021 Registrar of Vital Statistics .joy Bart(rolomew(ECectronicalTy Signed) (signature) District Number 4524 Place South Glens Falls Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 6 Date of Disposition 'a?t ZOZ/Place of Disposition ( �P �, ,-() Crevn4- o(address) (section) / (lot n tuber) (grave number) Name of Sexton or Person in Charge of Premi es ?P N1O✓✓D 1 Jcv c/ Z (please print) W . -Signature Title QfRie(� V DOH-1555(o7/t8)p t of 2 x U . 4 Public Health Law Sec. 4145(2b) Receipt 1 ' Human remains of . , - •I •`" -delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#