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Ruxton, SharonL. . . 11Pio NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex = i Sharon L.Ruxton Female , Date of Death Age If Veteran of U.S.Armed Forces, e 10/04/2020 68 Years War or Dates }.., Place of Death Hospital,Institution or Z City,Town or Village Johnsburg Town Street Address 351 Waddell Road,Johnsburg Town, New York 12886 Wp Manner of Death © Natural Cause ❑Accident El Homicide El Suicide 11 Undetermined El Pending W Circumstances Investigation LLI Medical Certifier Name Title 0 Kate Sauer-Jones PA Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village North Creek 5655 28 ❑Burial Date Cemetery,Crematory or Facility Name 1-1 10/07/2020 Pine View Crematory '❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation O Removal Date Place Removed and/or and/or Held H N Hold Address 0 a Date Point of Cl) Transportation Shipment by Common Carrier Destination ❑Disinterment Date Cemetery Address Date Cemetery Address ❑Reinterment a Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom }-.; Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/06/2020 Registrar of Vital Statistics th1een C.Lorah(E(ectronically Signed) (signature) District Number 5655 Place North Creek, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition /0I$I 20 Place of Disposition t11-,' /AL- w W (address) COC (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premis / " t..., tits Z. (P ase print /' , W Signature Title `"itTPVC. DOH-1555(07/18)p i of 2 I Public Health Law Sec. 4145(2b) 01_ 4 n 8 2 Receipt a i i Human remains of delivered on , 20; c I Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# " / 1