Bennett, Peter Raymond lall
NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Peter Raymond Bennett Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/132022 73 Years War or Dates 1969-1975
H Place of Death Hospital,Institution or
W City,Town or Village Abany Street Address Albany Medical Center Hospital
p• Manner of Death El NaturalCause Accident 0 Homicide Suicide ❑Undetermined ❑Pending
✓ Circumstances Invetion
W Medical Certifier Name Title
O Paul Marra Coroner
Address
112 State Street,Abany,New York 12207
Death Certificate Filed city cry District Number Register Number
City,Town or Village 0101 0655
X Burial Date Cemetery,Crematory or Facility Name
03/182022 Pine View Cemetery
Entombment Address
▪Cremation Queensbury Town,New York
n Donation
0❑Removal Date Place Removed
and/or and/or Held
N Hold Address
0
ii. Date Point of
(I)❑Transportation
a by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbtry,New York 12804
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
S Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/16/2022 Registrar of Vital Statistics DanieaS9 (th mrySO
(signature)
District Number 0101 Place city Of Albany
I certify that the remains of the decedentidentified above were disposed of in accordance with this permit on: ��]
W Date of Disposition I lJ '&c2 Place of Disposition c9/ <) i6�c,� 1S A q/K,--,,,s4ei,41# /3"2 ss/
ILI - 0)1)I.((lly 1
N cc (section) (tot nun7ber/ (grave number/
``
g Name of Sexton or Person in Charge of Premises /)/ ztck^"-/-
z (please print) �
Signature I
III Title
Title %n
.t
DOH 1555(07/18)p i of 2
Public Health Law Sec. 4145(2b)
612903
Receipt
)1( 1 ),_:-
Human remains of t - , , delivered on ' ' , 20
c \ , , -7#, A , ( , '
/ I
Pine View cemeter , Representing tlifuneral home named on burial permit
Official — Funeral Directors Reg.or License#/
BENNETT LF
NAME Peter Raymond Bennett Age' 73
Lot Owner: Edward & Beverly & Peter Bennett
Lot# Mohican 21 C Grave# 3
Case: Concrete
Died: 3. 1 3.2 2 Interred: 3 . 1 8.2 2
Funeral Home: Baker FH
Cemetery: Pine View