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Levy, Ruth -44k L.S. NEW YORK STATE DEPARTMENT OF HEALTH { `_ Vital Records Section ; Burial - Transit Permit Name First Middle Last Sex Ruth Levy Female Date of Death Age If Veteran of U.S. Armed Forces, August 26,2012 95 War or Dates Place of Death QU(2.541SbLAZ Hospital, Institution or Z City, Town or Village V ! Street Address Stanton Nursing& Rehab Centre tz Manner of Death AALF Natural Cause nc dent�n Homicide n Suicide n Undetermined n Pending ill Circumstances Investigation us Medical Certifier ��S�m1e'� ��r� �� Title a Address �U �U.n } 1`� is gC1 Death Certificate Filed Queensbuly. V District Number Register Number City, Town or Village 5657 ) d ❑Burial Date Cemetery or Crematory ❑Entombment August 29, 2012 Pine View Crematory Address ©Cremation Quaker Road, Queensbury, NY 12804 Date Place Removed Z + 1 Removal and/or Held 9 and/or Address �' Hold N 0 Date Point of N E Transportation Shipment p by Common Destination Carrier n Disinterment Date Cemetery Address El Reinterment Date Cemetery Address jv Permit Issued to Registration Number ;a Name of Funeral Home Regan& Denny Stafford Funeral Home 01443 -' Address 53 Quaker Road, Queensbury,NY 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address 're at `, Permission is hereby granted to dispose of the human rem ins escribed above aslindicated. Date Issued cl a� / egistrar of Vital Statistics q C (signature) District Number 5657 Place Queensbury,NY 12 10 IA I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Fw Date of Disposition $.nit Place of Disposition ,�,,�av C �,,p, 2 (address) Cl)LU Ce (section) A _ (lot number) S (grave number) ca Name of Sexton or Person in Charge of Premises G t„ t, Z /4 lease print) W Signature Title C+ .M told, (over) DOH-1555(02/2004)