Parker, Ruth NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
•+$ Name First Middle Last Sex
I0 Ruth Evelyn Parker Female
Date of Death Age If Veteran of U.S. Armed Forces,
I- February 17. 2006 80 War or Dates
Z Place of Death Hospital, Institution or
W City, Town, or Village Glens Falls Street AddressGlens Falls Hospital
c Manner of Death 0 Natural Cause ❑ Accident ❑ Homicide Suicide ❑ Undetermined piPending
uCircumstances Investigation
Medical Certifier Name Title
W ROSLYN SOCOLOF_MD
a Address
100 Broad St Plaza, Glens falls, NY
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls S 6 O I �yff
Date Cemetery or Crematory
❑X Burial February 22, 2006 Pine View Cemetery
Address
E Cremation Quaker Rd. Oueensbury, NY 12804-
Date Place Removed
0 ❑ Removal and/or Held
- and/or Address
Hold
0 Date Point of
0 ❑Transportation Shipment
a. by Common Destination
4 Carrier
Date Cemetery Address
a ❑ Disinterment
❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00284
Address
F 68 Main St., P. O. Box 67, Hudson Falls, New York 12839
Name of Funeral Firm Making Disposition or to Whom
a Remains are Shipped, If Other than Above
w Address
O.
Permission is hereby granted to dispose of the human remains de ribed abov as i i a ed.
Date Issued rtJA.ta,A ) a Registrar of Vital Statistics
(signature)
District Number 5 60 ) Place Glens Falls,New York
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 2/22/06 Place of Disposition PTNP VFW (.FMFTFRY,flIIFFNsRUPY NY
s
( )
N UNADILLA EXT. 53-C 3
t (section) (lot number) (grave number)
0
O Name of Sexton or Person in Charge of Premises M 1 CHAEL GEN I FR
w (please print)
Signature Title SUPT.
( f