Frank, Ruth NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Pe it
i•f f Name First Middle Last Sex
Ruth A. Frank Female
Date of Death Age If Veteran of U.S. Armed Forces,
• May 22, 2017 94 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Queensbury,NY Street Address Warren Center
Manner of Death n Natural Cause n Accident n Homicide n Suicide n Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Roslyn Socolof MD
Address
Gurney Lane Queensbury,NY
Death Certificate Filed District Number ,Re_gister Number
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City, Town or Village Queensbury,NY c ��]
❑Burial Date Cemetery or Crematory
El Entombment May 25, 2017 Pine View Crematorium
Address
II Cremation 51 Quaker Road, Queensbury,NY 12804
Date Place Removed
Z'n Removal and/or Held
and/or Address
Hold
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O Date Point of
yn Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
n Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Ba Road, $ueensbur , NY 12804 _
li Name of Funeral Firm Making Disposition or to Whom
;, - Remains are Shipped, If Other than Above Address
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Permission is hereb . granted to dispose of the human remains described e as indicated.
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NI Date Issued)cc-- I—) Registrar of Vital Statistics
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I certify that the remains of the decedent identified above were disposed of in accor• ith this permit on:
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Date of Disposition S)Zblf Place of Disposition i V �'�*a'FO',.;,,_
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O (section) ,.(lot number) (grave number)
Z• Name of Sexton or Person in Charge of Premises ��ra ik- Se IA lit
Z (pl se print)
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Signature !I Title raMkr -
(over)
DOH-1555(02/2004)