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Pratt, Ruth ,_1 i S37 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Ruth Margaret Pratt Female Date of Death Age If Veteran of U.S. Armed Forces, 07/28/2016 83 years War or Dates I- Place of Death Hospital, Institution or W City, TQCQ)(IV X110C Glens Falls Street Address Glens Falls Hospital W Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title a Michael Fuller M D Address 100 Park Street, Glens Falls, N Y 12801 M. Death Certificate Filed District Number Register Number City, TAU&NNW( Glens Falls 5601 385 ❑Burial Date Cemetery or Crematory 08/01/2016 Pine View Crematorium ['Entombment Address pCremation Queensbury, NY 12804 Date Place Removed Z ri❑Removal and/or Held 9. and/or Address hi-. Hold Cl) O Date Point of GL 0 Trin ansportation Shipment C by Common Destination Carrier ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M. B. Kilmer Funeral Home 01078 Address 82 Broadway Fort Edward, N Y 12828 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above ,'; Address Ir III a` Permission is hereby granted to dispose of the human remains d cribe ajo?bove a 'cated. Date Issued 08/01/2016 Registrar of Vital Statistics 2c/ ` z� . (signature) District Number 5601 Place Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: til p 21,Uti-' 1• Date of Disposition �/2/ID Place of Dis osition rt/" 2 (address) UI Ul. C (section) �J/ (lot number) (grave number) ° Name of Sexton or Person in Ch ge of Premises f, t (please print) 3t! Signatureiji f Title � � (over) DOH-1555 (02/2004)