Whiting, Ruth III
.
NEW YORK STATE DEPARTMENT OF HEALTH Burial Transit Permit
Vital Records Section
r
Name First Middle Last Sex
Ruth E. Whiting Female
f: Date of Death Age If Veteran of U.S. Armed Forces,
▪ January 10, 2015 84 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Fort Edward Street Address Fort Hudson Nursing Home
gi Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
0. Eileen Spinelli MD
..::: Address
▪ 9 Carey Rd,Queensbury,NY 12804
▪ : Death Certificate Filed District Number Register umber
_ City, Town or Village Fort Edward 5755
0 Burial Date Cemetery or Crematory
January 14, 2015 Pine View Cemetery
❑Entombment Address
❑Cremation Quaker Road, Queensbury, , NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
..' Hold
U)
O Date Point of
NTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment 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 hereb granted to dispose of the huma ' s described ove a indicated.
.rj. Date Issued I Registrar of Vital Statistics .. bilk)
(signature)
District Number 5755 Place Fort Edward
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 1 /1 4/2 01 cplace of Disposition 21 Ouaker Rd. , Queenshnry, NY 12804
2 (address)
W
U) Seneca 2B 2
re (section) (lot number) (grave number)
pName of Se n or Person in Charge of Pre " s Connie Goedert
Z (please print)
W Si nature %-'c ' Title Cemetery Superintendent
9
(over)
DOH-1555(02/2004)