Ryder, Charles H. NEW YORKSTATE DEPARTMENT OF HEALTH Burlap - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Charles H Ryder Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/21/2020 92 Years War or Dates 1944-1949
Place of Death Hospital,Institution or
Z City,Town or Village Guilderland Town Street Address The Grand at Guilderland
p Manner of Death �Natural Cause ❑Accident ❑Homicide Suicide Undetermined Pending
UCircumstances Investigation
WQ Medical Certifier Name Title
Jonathan Waldman MD
Address
127 Main St,Guilderland Town,New York 12085
Death Certificate Filed District Number rgislr Number
City,Town or Village Guilderland 0155 79
Burial Date Cemetery,Crematory or Facility Name
04/23/2020 Pineview Crematory
Entombment Address
X❑Cremation Queensbury Town,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
H Hold Address
N
O
a Date Point of
U) Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
Address
7 Sherman Ave,Corinth,New York 12822
Name of Funeral Firm Making Disposition or to Whom
F— Remains are Shipped,If Other than Above
.� Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/22/2020 Registrar of Vital Statistics Lynne Buchanan(Electronically Signed)
(Signature)
District Number 0155 Place Guilderland, 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 /,/-2Z-2 0 2 e)Place of Disposition f lh e • a� (. ,-e yy, p„ �
Uj (address)
w
fR
Q (section) (lot number) /gra ve number)
Name of Sexton or Person i e of Premises 3 t 6.;,pm G e—
(pleaseprint)
W Signature Title G1lQ�yl rc /
DOH-1555(07/18)p t of 2
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Public Health Law Sec. 4145(2b) ; Fa
Receipt
y
Human remains of delivered on , 20
Pine View Cemetery Represefitng'tiie funeral home named on burial permit
Official Funeral Directors Reg.or License#