Loading...
Petry, Ruth NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Ruth Myrtle Petry Female Date of Death Age If Veteran of U.S.Armed Forces, 12/20/2017 90 Years War or Dates Place of Death Hospital, Institution or III City, Town or Village Ticonderoga Town Street Address Heritage Commons Residential Health Care Manner of Death©Natural Cause 0 Accident 0 Homicide 0 Suicide 0 Undetermined ri Pending Fl Circumstances Investigation Medical Certifier Name Title Kathleen Huestis MD Address 5,1 102 Racetrack Road,Ticonderoga Town,New York 12883 ict Death Certificate Filed District Number i Register Number 17, City, Town or Village Ticonderoga 1564 48 ['Burial Date Cemetery or Crematory $ 12/22/2017 Pine View Crematory 1 El Entombment Address • ®Cremation Queensbury, New York Date Place Removed Removal and/or Held frz and/or Address ` "Hold tj Date Point of Transportation Shipment by Common Destination iii Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address • Permit Issued to Registration Number Name of Funeral Home Wilcox&Regan 01821 rAl Address 11 11 Algonkin St,Ticonderoga,New York 12883 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above • Address 9 14 `'3 Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/21/2017 Registrar of Vital Statistics Tonya11T(ompson ECectronica1Tystgned 044 (signature) District Number 1564 Place Ticonderoga, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition )2J2zI/1 Place of Disposition �/)1QiJ s Grth,twhry 0 / (addreds) rill t (section) 1 (! umber) (grave number) r ac Name of Sexton or Pn Charge of Premises t-/r1�✓r .wt ��c.4 rC 7.L. (please Wit)SignatureTitle Lrz,n h k//". ,71 (over) DOH-1555 (02/2004)