LeBarron, Ruth NEW YORK STATE DEPARTMENT OF HEALTH b
Vital Records Section Burial - ansit Permit
Name First Middle Last I Sex
Ruth LeBarron Female
Date of Death Age If Veteran of U.S. Armed Forces,
January 27, 2012 I 79 War or Dates
I..' Place of Death I Hospital, Institution or
Z City, Town or Village Glens Falls j Street Address Glens Falls Hospital
GManner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
U Circumstances Investigation
LI
uj Medical Certifier Name Title
0 Mark Hoffman MD
Address
100 Park Street Glens Falls NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 37
❑Burial Date Cemetery or Crematory
January 30, 2012 Pine View Crematorium
❑Entombment Address
❑x Cremation 21 Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
0 Date Point of
WTransportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
1
Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Funeral Home 01443
Address
53 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
I- Remains are Shipped, If Other than Above
g Address
W
a
Permission is hereby granted to dispose of the human remains descri ed a ov s in t d.
Date Issued ®/�(S�ZO/2— Registrar of Vital Statistics
(signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were dispos d of in accordance with this permit on:
Z /'
W Date of Disposition I/31/►2 Place of Disposition I,v Ut iv („rvnc4or•1u,.
W (address)
Cl)
ct (section) _ ( t number) ( (grave number)
00 Name of Sexton or Perso in Charge of remises A'1 P P11r1'l}
'LI Z thi
please print)
Signature Title Cl2 r n)T 0Q
(over)
DOH-1555(02/2004)