Schies, Virginia Ruth (3
NEW YORKSTATE DEPARTMENT OF HEALTH ` - tat - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Virginia Ruth Schies Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/31/2019 98 Years War or Dates
II.— Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address The Pines At Glens r alls Center For Nursing&Rehabilitation
WW Manner of Death
❑n Natural Cause Accident Homicide Suicide Undetermined Pending
C.) Circumstances Investigation
W Medical Certifier Name Title
Wendy Steinhacker PA
Address
170 Warren St,Glens Falls,New York 12801
Death Certificate Filed District Number 7566'�
ter Number
City,Town or Village Glens Falls 5601
Burial Date Cemetery,Crematory or Facility Name
01/06/2020 Pine View Crematory
Entombment Address
DR]Cremation Town of Queensbury,New York
Donation
zRemoval Date Place Removed
and/or and/or Held
H CO) Hold Address
O
Ill. Date Point of
N n Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
JE]Reinterment__�
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
}- Remains are Shipped,If Other than Above
Address
ilr
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/02/2020 Registrar of Vital Statistics TpAerr q7 rewCurtzr(EketronicatTy Signed)
(signature/
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
Z Date of Disposition 114110 Place of Disposition
W
� (address)
W
NIt (section) (lot number), /grave number/
aName of Sexton or Person in Charge of Premises
Z (p ase print/
W Signature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) ` 13 0 7
Receipt
Human remains of delivered on { , 20
4
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#