Benjamin, Sharon A (i...........e-NEW YORKSTATE DEPARTMENT OF HEALTHBurial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Sharon A. Benjamin Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/14/2022 75 Years War or Dates
i_ Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death ❑Natural Cause Accident Homicide Suicide Undetermined In Pending
W Circumstances I 'Investigation
U
W Medical Certifier Name Title
0 Matthew Loftus PA
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 366
ElBurial Date Cemetery,Crematory or Facility Name
07/18/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
H Hold Address
U)
0
d Date Point of
U)ETransportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
nDisinterment
0 Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Brewer Funeral Home Inc 00211
Address
24 Church Street PO Box 500, Lake Luzerne, New York 12846
Name of Funeral Firm Making Disposition or to Whom
1— 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 07/18/2022 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 -7I jgJu Place of Disposition 41„ii......„ 11,401U.-..
W
2 (address)
W
U)
CC (section) (tot number) (grave number)
Name of Sexton or Person in harge of Premise M lls._ ç. 4ti
Zplease print)
W Signature r� Title r�
DOH-1555(07/18)p 1 of 2
C � , 7 33
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License#