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Ruiz, Daniel NEW YORK STATE DEPARTMENT OF HEALTH BUI'Ia• I - Transit Permit Vital Records Section >< Name First Middle Last Sex Ili Daniel Edward Ruiz Female Date of Death Age If Veteran of U.S. Armed Forces, March 23, 1995 _ 30 War or Dates Yes si Place of Death Hospital, Institution or City, Town or Village Glens Falls New York Street Address Glens Falls Hospital Manner of Death❑Natural Cause n Accident 0 Homicide 0 Suicide ®Undetermined r_i©Pending Circumstances Investigation I Medical Certifier Name Title Richard Letvak M.D. Address 100 Park. Street Glens Falls, New York 12801 = - Death Certificate Filed District Number Register Number >< City, Town or Village Glens Fa1lE N Y. 5601 //"/ Date Cemetery or Crematory 0 Burial March 27, 1995 _ Pine View Cemetery Address Ciematiun •- Quaker Road Queensbury, New York Date Place Removed . Z❑Removal and/or Held and/or Address tg Hold Date Point of c,�[�Transportation Shipment A by Common Destination Carrier Disinterment Date Cemetery Address [D Reinterment Date Cemetery Address v Permit Issued to Registration Number Name of Funeral Home S ingleton-Healy Funeral Home Inc. 01807 ' Address 10 407 Bay Road Queensbury, New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above . . Address Permission is hereby granted to dispose of the human remains describ d above asd Cam `indic d. ie ��� / ' Date Issued March 27, 1995Registrar of Vital Statistics ,��-'�' (signature) Ai District Number 5601 Place Glens Falls, Ncw York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: h Date of Disposition 3/27/95 Place of Disposition Pine View Cemetery Oueenshruy (address) tn Mohican ' 74 E 1 0. (section) (lot number) (grave number) Ot\fame of Sexton or Person in Charge of Premises Michael Lopez V (please print) Signature i Title Working Foreman DOH-1555 (10/89) p. 1 of 2 VS-61