Freeland, Ruth i
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit�ermit
Vital Records Section
Name First Middle Last Sex
Ruth Taylor Freeland Female
', Date of Death Age If Veteran of U.S. Armed Forces,
May 12, 2017 90 War or Dates
•
''' P• lace of Death Hospital, Institution or
City, Town or Village Queensbury Street Address 104 Seelye Road
Manner of Death ❑X Natural Cause ❑Accident ❑Homicide ❑Suicide Undetermined Pending
uitCircumstances Investigation
M• edical Certifier Name Title
C• raig Emblidge,MD
Address
Glens Falls,NY
Death Certificate Filed District Number Register Number
C• ity, Town or Village Queensbury, NY 5657 LIj
❑Burial Date Cemetery or Crematory
❑Entombment May 16,2017 Pine View Crematorium
Address
❑x Cremation 51 Quaker Road, Queensbury, NY 12804
Date Place Removed
ZO ❑Removal and/or Held
and/or Address
H Hold
U)
O Date Point of
yTransportation Shipment
p by Common Destination
Carrier
► Disinterment Date Cemetery Address
El Reinterment Date Cemetery Address
1 Permit Issued to Registration Number
N• ame of Funeral Home Regan Denny Stafford Funeral Home 01443
1 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 reC a'nn des"crib bo indica-d.
Date Issued 5-{ ;O i'7 Registrar of Vital Statistics _ r),t
. r signature)
District Number (i6 Place I I otyc\,\ r
I certify that the remains of the decedent identified abdv were disposed of in ac dan a with this permit on:
Z
W Date of Disposition s-(IL 1n Place of Disposition '54(0„N.- (4rnq#a;+..
2 (address)
W
O (section) (lot number) t (grave number)
p ///Name of Sexton or Person in Charge of Premises /h r is ,w S m'it
Z (ease print)
W Signature Title `(F 111A-
t
(over)
DOH-1555(02/2004)