Waggaman, Ruby NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Biostatistics-Vital Records Section
Name First Middle Last Sex
Ruby Waggaman Female
Date • ....... .......
imi of Death Age .... If Veteran of U.S.Armed Forces,
3/5/88 86 War or Dates
Place of Death Hospital, Institution or .............................
lij City,Town or Village City of Glens Falls Street Address Glens Falls Hospital
.. Cause of Death
cardiogenic shock
€4;+.:::::::::::. .:::::::::::::.:::::::::::.::::::::::::::::.::::::::::::::::::::::::::::::::::::.:::::::.:::::::::::::::: :::..........: ..............................................................................................................
la Medical Certifier Name Title ::
3 Vitale H. Paganelli MD
Address:::::.................................................................................................................................................. ..................................................
7 Murray Street, Glens Falls, N.Y. 12801
Certificate Filed District Number Register Number
ggii City,Town or Village City of Glens Falls .5-��0/ /aMi
Date Cemetery or Crematory
LS Burial 3/8/88 Pine View Cemetery
;; 0 Cremation ss
Town of Queensburs , N.Y.
:::::..::..............................
.....
Date
:::::....................................... .
.................................
z. Place Removed
o 0 Removal and/or Held
and/or Hold old :::::::::::::::::::.�::................................................................................................. .................................. ........................................ ...
Address
tL Date Point of
0 0 Transportation by ': Shipment
Co .................................................................!p mmon Carrier '>���•���--
Destination
Date::::::..................................................... ...........................................................................................
el ❑ Disinterment Cemetery A ress
Date::::......................................:..............
❑ Reinterment Cemetery Address
im Permit Issued to Registration Number
Name of Funeral Firm Regan and Denny Funeral Home, Inc. 02883
...................................................................................................................................
mi
Address
40 Quaker Road, Glens Falls, N.Y. 12801
. Name of Funeral Firm Making Disposition or to Whom
izi Remains are Shipped, If Other than Above
te Address
Itli
:tk:
Permission is hereby granted to dispose of the hum re ain , escribe above as indicated.
'` Date Issued If Registrar of Vital Statistics ,,'��`/ ,,%� .�.-� �Q..
ignature)
`" District Number 5607 Place ..," G,,c�
iiiiii I certify that the remains of the decedent identified above were dispose in accordance with this permit on:
z. Date of Disposition .�-�?-eg. Place of Disposition , yvP Vi to C�
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AILSignature ��.,1il�rrlt o.�. Title c��V p,
DOH-1555(9/86)p 1 of 2(formerly VS-61)