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Calhoun, Ruth - 1 n NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit • Name First Middle Last Sex Ruth Margaret Calhoun Female Date of Death Age If Veteran of U.S. Armed Forces, 02/03/2018 95 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause 0 Accident D Homicide n Suicide riUndetermined 0 Pending Circumstances Investigation Medical Certifier Name Title 1' Scott Biasetti MD 5 t-_ Address i 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number 2/6 City, Town or Village Glens Falls 5601 65 A❑Burial Date Cemetery or Crematory ' 02/05/2018 Pine View Crematory ' ❑Entombment Address ®Cremation Queensbury Town, New York Date Place Removed Removal and/or Held and/or Address Hold ia a Date Point of Transportation Shipment by Common Destination Carrier 1 ❑Disinterment , Date Cemetery Address i Date Cemetery Address ix Q Reinterment Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077 Address 123 Main St,Argyle,New York 12809 wit Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address t Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/05/2018 Registrar of Vital Statistics RgbertA Curtis(E(ectronica(CySigned) (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: Date of Disposition Z f 4 (I� Place of Disposition firsJ--/ /.�-•`t`- (address) ad e_ (section) 4 (lot number) (grave number) Name of Sexton or Person in Charge of remises E�lh• S""'`tt / (Pit ale print) e,'4 Signature Title "''1f ''' (over) DOH-1555 (02/2004)