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Bennett, Theresa Marie ( )ImuF # /43 . NEW YORK STATE DEPARTMENT OF HEALTH _ Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Theresa Marie Bennett Female Date of Death Age If Veteran of U.S.Armed Forces, 05/19/2023 57 Years War or Dates 1,,. Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death El Natural Cause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation U W Medical Certifier Name Title CI Marcille Labban 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 261 Burial Date Cemetery,Crematory or Facility Name . 05/23/2023 Pine View Crematorium Entombment _ Address ©Cremation Queensbury Town,New York [ ]Donation Q❑Removal Date Place Removed and/or and/or Held _ I-- Hold Address to 0 a Date Point of Cl)❑Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom F. Remains are Shipped,If Other than Above Address IE a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/23/2023 Registrar of Vital Statistics Megan No(in(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: z (� � 1__... 111 Date of Disposition � � it, Place of Disposition �, 2, (address) W NCC (section) (lot number) (grave number) AIL 0Name of Sexton or Person in Cg mises lease print) W Signature Title t ifidt DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on b x.al,permit Official Funeral Directors Reg.or License# —