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Rottingen, Ruth NEW YORK STATE DEPARTMENT OF HEALTH - Yirt ft 61-2 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Ruth Jayne Rottingen Female Date of Death Age If Veteran of U.S. Armed Forces, February 1, 2017 92 War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death 0 Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending Circumstances Investigation Medical Certifier Name Title Nawed A. Siddiqui, M.D. Dr. Address 100 Park Street Glens Falls, NY 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5 6 G ) "Z 5 ❑Burial Date Cemetery or Crematory February 3, 2017 Pine View Crematory ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed Removal and/or Held and/or Address Hold Date Point of ❑Transportation Shipment c by Common Destination O Carrier Date Cemetery Address ❑ Disinterment ❑ Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M.B. Kilmer Funeral Home-SGF 01078 Address 136 Main Street, South Glens Falls NY 12803 Name of Funeral Firm Making Disposition or to Whom 1 Remains are Shipped, If Other than Above Address ir MI Permission is hereby granted to dispose of the human remains described above as indicated. Date issued,)3 j i 7 Registrar of Vital Statistics t )°A.A.,1 .Q U .. 11)1 r (signatu District Number 560 ) Place 6 (avv S 11 S N) u I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 02/03/2017 Place of Disposition Quaker Road Queensbury,NY 12804 (address) ig IE (section) Allot number) c (grave number) 0 Name of Sexton or Person in Charge of remises L �C� r Jtn'►(t1 ( ease print) �» Signature �� CRIl�Y1 � g Title (over) DOH-1555 (02/2004)