O'Keeffe, Ruth 1
NEW YORK STATE DEPARTMENT OF HEALTH r,
Vital Records Section Burial - Transit Permit
ti Name First Middle Last Sex
Ruth M. O'Keeffe Female
Date of Death Age If Veteran of U.S. Armed Forces,
March 31, 2016 74 War or Dates
90
Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address 12 Old Coach Road
Manner of Death X Natural Cause 0 Accident n Homicide Suicide C Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Gerald F Abess MD
. Address
3 Irongate Center
f% Dea i i to Filed t/r�iic,�t^Number R�gis Number
Cit , Town or ilia e
❑BunaT Date Cemetery or Crematory
April 5, 2016 Pine View Crematorium
❑Entombment Address
El Cremation 51 Quaker Road,Queensbury,NY 12804
Date Place Removed
Cn Removal and/or Held
and/or Address
H Hold
Cl)
0 Date Point of
O.
Transportation Shipment
a by Common Destination
Carrier
n Disinterment Date Cemetery Address
1-1 Reinterment Date Cemetery Address
''''I Permit Issued to Registration Number
Name of Funeral Home Regan Dennytafford Funeral Home 01443
g Y
f, , Address
A 53 Quaker Road,Queensbury, NY 12804
0 j.
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 re ins described abqve
`X acated.
'r,
i
off Date Issued \--�/ )0)t(� Registrar of Vital Statistics C.�
(signature)
f{ District Number, l
{{ �lS� Place (�t'1 ( CR 1 -12 b
.„,,,
F- I certify that the remains off the decedent identified above were disposed of inn accordan�+e with his permit on:
W Date of Disposition t/(P 1 ji, Place of Disposition gu..VF— C+ eng--
g (address)
W
W (section) , (/pt number) (grave number)
pName of Sexton or Person in Charge of Premises CA ft,tf.*, IA,*
Z �/ (pl se print)
LU
Signature Title t' A
(over)
DOH-1555(02/2004)