Vincent, Ruth 130
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Ruth C Vincent Female
f. Date of Death Age If Veteran of U.S. Armed Forces,
February 14, 2017 91 War or Dates
' Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address 260 South Street
Y 9
Manner of Death n Natural Cause ❑Accident ❑Homicide n Suicide n Undetermined Pending
Circumstances Investigation w
Medical Certifier Name Title
x;,. James North
Address
4. 100 Broad Street,Glens Falls,NY 12801 _
Death Certificate Filed District Number Regi tecumber
City, Town or Village Glens Falls 5601
❑Burial Date Cemetery or Crematory
❑Entombment February 15,2017 Pine View Crematory
Address
®Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
2 ElRemoval . and/or Held
and/or Address
F" Hold
N
O Date Point of
Nn Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
n Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
/ ` 53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human rains d scribed above as i dicatt .
<f Date Issued D315 ajt Registrar of Vital Statistics �?� 2 ..-'�'''�'
off .
::::4 District Number Place
5601 Glens Falls
ki
I certify that the remains of the decedent identified above wer disposed of in accordance with this permit on:
Z
UJDate of Disposition Z/f7J, '7 Place of Disposition M,� v, (,td G r_i'fr 4 7 el
W / (address)
co
0' (section) \ (19t number) (grave number)
p Name of Sexton or Pers n in Charge of Premises . Li-/I C2 t t (24-V4'4-Ul e'
Z (please print)
W Signature ✓.t' i'�'f`/" -" Title L. �n7G..4irl v z';�1d----
r (over)
DOH-1555(02/2004)