Dunbar, Ruth NEW YORK STATE DEPARTMENT OF HEALTH t J 1`
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Ruth S. Dunbar Female
Date of Death Age If Veteran of U.S. Armed Forces,
7/19/16 86 War or Dates N/A
Place of Death Hospital, Institution or
ZCity, Town or Village Albany Street Address Albany Medical Center Hospital
Manner of Death®Natural Cause 0 Accident 0 Homicide Suicide Undetermined Pending
IliCircumstances Investigation
Medical Certifier Name Title
gi Nicholas Field M.D.
Address
43 New Scotland Ave., Albany, NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village
30Burial Date Cemetery or Crematory
07/21/16 Pine View Crematorium
0 Entombment Address
:®Cremation Queensbury, NY
Date Place Removed
0 Removal and/or Held
and/or Address
Hold
Date Point of
Transportation Shipment
by Common Destination
Carrier
0 Disinterment Date Cemetery Address
li!``j Date Cemetery Address
ii:ii ❑Reinterment
`'> Permit Issued to ! Registration Number
`» Name of Funeral Home Alexander Baker Funeral Home 00037
Address
•::.>_ 3809 Main St., Warrensburg, NY 12885
i. 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 remains described above as indicated.
> ':j Date Issued 7/20/16 Registrar of Vital Statistics ,( -.t{. rn �--
gil r (signature)
District Number 101 Place Police Dept., City of Albany, Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z n
i Date of Disposition 7 PIA, Place of Disposition �,nt Jit..../ rrs.,r►Otvr1r,,.
(address)
tii
Crtil
(section) (lot number) ,�/ (grave number)
0.
el Name of Sexton or Person in Charge of Premises - I,c 3t^. *
Z /; (please print)
Signature t/`- -- Title C IVItl-117C_
(over)
DOH-1555 (02/2004)