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Ruff, Pearl Frances 'j17 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Pearl Frances Ruff Female Date of Death Age If Veteran of U.S.Armed Forces, 02/02/2020 98 Years War or Dates F Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing W Manner of Death Undetermined Pending W © Natural Cause ❑Accident Homicide Suicide Circumstances Investigation W Medical Certifier Name Title G Roslyn Socolof MD Address 42 Gurney Ln,Queensbury Town, New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 20 ❑Burial Date Cemetery,Crematory or Facility Name 02/04/2020 Pine View Crematory Entombment Address Cremation Queensbury Town,New York Donation z Removal Date Place Removed and/or and/or Held ~ Hold Address O a Date Point of (0) ElTransportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom (.- Remains are Shipped,If Other than Above Address Ilr W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/04/2020 Registrar of Vital Statistics CaroC'ne7fi(degardeBar6er(6CectronicaCCySigned) (signature) District Number 5657 Place Queensbury, 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 Place of Disposition i ►" 0.f� W (address) W Q (section) Aot number/ (grave number) 0 Name of Sexton or Person in Char a of Premis, (ple a print) W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) C 1 ' h 2 Receipt P Human remains of 'r delivered on , 20 4 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#