Bennett, Richard Edmund . ; v... 526
NEW YORKSTATE DEPARTMENT OF HEALTH \ . B ;ial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Richard Edmund Bement Male
Date of Death Age If Veteran of U.S.Armed Forces,
06/29/2022 88 Years War or Dates
F, Hospital,Institution or
Place of Death P
WCity,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death 0 Natural Cause Accident El Homicide ESuicide FlUndetermined Pending
W
U Circumstances Investigation
W Medical Certifier Name Title
t7 Marvin Davidowitz MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 348
Burial Date Cemetery,Crematory or Facility Name
® 07/01/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
Date Place Removed
❑Removal and/or Held
H and/or
CO
Address
0
Date Point of
U)ElTransportation Shipment
p by Common —
Carrier Destination
O
Disinterment
Date Cemetery Address
El Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079
Address
82 Broadway,Fort Edward,New York 12828
Name of Funeral Firm Making Disposition or to Whom
F— Remains are Shipped,If Other than Above
2 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/01/2022 Registrar of Vital Statistics Megan Nolin(Electronically Signed)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I- �
Z Date of Disposition 7a�Zoz Z Place of Disposition $ ' a e,c) Cre-Mp frs
W (address)
W
U) (section) �/ (lot number) (grave number)
Name of Sexton or Person in Charge remis f'A` '0 'b (/V oD
�� (please print
Z Lye'k4 C
W Signature 6 Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) �I..60 3
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#