Sink, Ruth I
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Ruth V. Sink Female
Date of Death Age If Veteran of U.S. Armed Forces,
October 18, 2015 93 War or Dates Nos v�j
, Place of Death Hospital, Institution or I
City, Town or Village Glens Falls Street Address 6 Kensington Road
Manner of Death U Natural Cause n Accident n Homicide ❑Suicide n Undetermined Pending
W Circumstances Investigation
8 Medical Certifier Name Title
0` James North,MD
Address
Glens Falls,NY
Death Certificate Filed District Number Register
City, Town or Village Glens Falls NY, 5601 ,,,//
❑X Burial Date Cemetery or Crematory
October 21, 2015 Pine View Cemetery
❑Entombment Address
El Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z ❑Removal and/or Held
and/or Address
E Hold
N
0 Date Point of
Nn Transportation Shipment
p by Common Destination
Carrier
Li Disinterment Date Cemetery Address
n Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury,NY 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 descri ed a ov as ' i ted.
Date Issued /i.�20�2FJ4J Registrar of Vital Statistics
� 4
(signature)
District Number 56d/ Place 6/�-25 ra/Js, ,/„y / ft/
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ulDate of Disposition 1 0/21 /1 5 Place of Disposition Pine View Cemetery, Queensbury, NY
2 (address)
111
U) S.I. 189 Sec. 2 2
p0 (section) (lot number) (grave number)
Name of Sext or Person in Charge of Premises Connie L. Goedert
Z �O (please print)
ill Signature (ti. Title Cemetery Superintendent
(over)
DOH-1555(02/2004)