Durso, Virginia .10 it g03
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
" Name First Middle Last Sex
IQ
i Virginia Ruth Durso Female
Date of Death Age If Veteran of U.S. Armed Forces,
z 10/25/2017 98 Years War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitati
Ip Manner of Death X❑Natural Cause El Accident n Homicide ❑Suicide ❑Undetermined Pending
Circumstances Investigation
ju Medical Certifier Name Title
9 Gwendolyn Morris-Dickinson PA
Address
rc, 170 Warren St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 549
,OBurial Date Cemetery or Crematory
p 1-1❑Entombment 10/26/2017 Pine View Crematory
Address
Y:®Cremation Queensbury Town, New York
Date Place Removed
Y.
ri❑Removal and/or Held
.2 and/or Address
Hold
CO
O Date Point of
N❑Transportation Shipment
G by Common Destination
A':b. Carrier
ritL. Disinterment Date Cemetery Address
Q Reinterment
SI
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
f' Remains are Shipped, If Other than Above
2 Address
EL
tw
CL
> Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/26/2017 Registrar of Vital Statistics Ro6er t A Curtis ECectronicatTySigned
(signature)
District Number 5601 Place Glens Falls, New York
HI certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
ILI Date of Disposition 10/31 I n Place of Disposition fL t .,r el
usi-c{Qt�
(address)
Ch
(section) � (lot number) (grave number)
0p Name of Sexton or Person in Charge of Pre .ses L��� S ► �
Z 'el
(plea a print)
Signature 1'L P7' Title t(�In'1� .1'L
(over)
DOH-1555 (02/2004)