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Allen, Ruth NEW YORK STATE DEPARTMENT OF HEALTI-1r % ti7m(__i Vital Records Section f �� Burial - Transit a t Name First Middle Last Sex • Ruth M. Allen Female Date of Death Age If Veteran of U.S. Armed Forces, 09/22/2011 92 years War or Dates }-- Place of Death Hospital, Institution or City, Tyr IR Saratoga S',ringc Street Address Saratoga Hospital • Manner of Death©Natural Cause Accident ❑Homicide ❑Suicide ❑Undetermined El Pending W Circumstances Investigation la Medical Certifier Name Title PI Mark Weidner M D Address 211 Church Street, Saratoga Springs, N Y 12866 Death Certificate Filed District Number Register Number City, TR QrAi gR Saratoga Springs 4501 412 ['Burial Date Cemetery or Crematory ❑Entombment Address 09/26/2011 Pineview Crematorium ]Cremation Queensbury N Y" Date Place Removed • Removal and/or Held ... and/or Address -= Hold tf) 0 Date Point of 05❑Transportation Shipment G by Common Destination Carrier Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home 00448 Address 7 Sherman Ave, Corinth, New York 12822 Name of Funeral Firm Making Disposition or to Whom 1 . Remains are Shipped, If Other than Above • Address tr. ILI f'' Permission is hereby granted to dispose of the human remain =la ' dicated Date Issued 09/23/2011 Registrar of Vital Statistics (signature) District Number 4501 Place Saratoga Springs I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: k LU Date of Disposition (Mtbf It Place of Disposition .Ptu ) ('rvr►.c kV({U., 2 (address) lit (section) (1 t number) (grave number) ci Name of Sexton or Pe son in Charg of Premises +b 0' S, z _` ( ease print) Signature y�L.. Title `tAL Y (over) DOH-1555 (02/2004)