Benson, Betty Louise ilDc
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NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Betty Louise Benson Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/16/2022 88 Years War or Dates
H Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death Natural.Cause Accident El Homicide ESuicide nUndetermined ❑Pending
W Circumstances Investigation
U W Medical Certifier Name Title
O David Cunningham MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 477
RBurial Date Cemetery,Crematory or Facility Name
09/20/2022 Pine View Crematory
Entombment Address
x Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
f- Hold Address
to
0
O. Date Point of
U)❑Transportation Shipment
p by Common
Carrier Destination
Disinterment Date Cemetery Address
0 Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
F— Remains are Shipped,If Other than Above
2 Address
CC
W
0.. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/20/2022 Registrar of Vital Statistics Wegan Wolin(ECectronicafrySigned)
(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:
H
W Date of Disposition i 127,(1Z Place of Disposition (address)
W
N LC (section) A _Ilot number (grave number)
C�
8 Name of Sexton or Person in Charge of remises 9' , rl
Z ( ease print)
W /�Signature Title lrn���
DOH-1555(o7/t8)p 1 of 2
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01, E2 :,. Ct
Public Health Law Sec. 4145(2b)
Receipt
1
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Human remains of delivered on , 20
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Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License#