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Bentley, Robin H ..( ilf . g L(03 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robin H.Bentley Female Date of Death Age If Veteran of U.S.Armed Forces, 08/18/2023 63 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital 1111 p Manner of Death Natural Cause nAccident El Homicide Suicide nUndetermined ❑Pending W ` I1Circumstances Investigation U W Medical Certifier Name Title CI Asim Chaudry ' 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 389 E Burial Date Cemetery,Crematory or Facility Name 08/21/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York ▪Donation 0❑Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 d Date Point of (/)ETransportation p by Common Shipment Carrier Destination ODisinterment Date Cemetery Address EIReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above a Address CC ILL) n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/21/2023 Registrar of Vital Statistics Megan Horn(Ekctronica/TSigned) (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 Date of Disposition g)Tz 1.7.3 Place of Disposition -P1L_.. �,EK W 2 (address) W Cl) CC (section) (tot number/ c. (grave number/ 0 Name of Sexton or Person in Charge o mises Ll!• Z (lase print) /��� MI Signature Title (F^^'w Pt DOH-1555(07/18)p 1 of 2 I 721.2 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#