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Gonzalez, Benjamin ( L9 26t NEW YORKSTATE DEPARTMENT OF HEALTH Y Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Benjamin Gonzalez Male Date of Death Age If Veteran of U.S.Armed Forces, 10/25/2023 88 Years War or Dates 1.. Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital ILI Manner of Death ZNatural CauseAccident Homicide Suicide UndeterminedPending 0 Circumstances Investigation 0IJJ Medical Certifier Name Title Gamal Khalifa 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 495 Burial Date Cemetery,Crematory or Facility Name 10/27/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation 6❑Removal Date Place Removed F and/or and/or Held CO Hold Address 0 O. Date Point of U) Transportation Q by Common Shipment Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address El Reinterment • Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom H 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 10/27/2023 Registrar of Vital Statistics Megan Not-in(ECectronicatry 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 A0-27 Z 3 Place of Disposition sq,)e .Q_ C'f`P „-h fi W 2 (address) W Cl) Q (section) ` (lot number)) (grave number) 8 Name of Sexton or Person in Charge of P mises 1>F}1'HIO' , �U.6d Z (please print) IliSignature Title Of-ejL1, /9c-- DOH-1555(o7/i8)p 1 of 2 Y Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 PineView Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#