Ritchie, Scott NEW YORK STATE DEPARTMENT OF HEAL-ill 71 37 t
Vital Records Section v Burial - Transit Permit
St Name First Middle Last Sex
la Scott Thomas Ritchie Male
Date of Death Age If Veteran of U.S. Armed Forces,
May 19, 2015 63 War or Dates
Place of Death Hospital, Institution or
,r City, Town or Village Albany Street Address
ai Manner of Death r,
L j Natural Cause 0 Accident El Homicide D Suicide 17Undetermined ri Pending
Circumstances Investigation
l Medical Certifier Name Title
Howard Silverberg, Dr.
',,;4,, Address
0 Kingsbury Health Center Fort Edward, NY 12828
Death Certificate Filed District Number Register Number
City, Town or Village z-la() 7
0 Burial Date Cemetery or Crematory
May 21, 2015 Pine View Crematorium
1 v.❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
ats Date Place Removed
t ID Removal and/or Held
and/or Address
Hold MAPLE GROVE CEMETERY
#24, Date Point of
❑Transportation Shipment
by Common Destination
a„ Carrier
Disinterment Date Cemetery Address
_ '� Reinterment
Date Cemetery Address
,i Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
r4 Address
,h,,,, Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
`' ' Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2° Address
Vali
Permission is hereby granted to dispose of the human r ' s described above as indicated.
Date Issued 5 a) jpj S Registrar of Vital Statistics .
,* (signature)
District Number5rja,(, Place V _, ZO i�_4_A...z
v
,. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 05/21/2015 Place of Disposition Quaker Road Queensbury,NY 12804
7,1 (address)
n Ritchie Lot/Lot
' 2 y 1 of (lot number (grave number)
Name of Sexton or Person in Ch a of Premises l
(please print)
Signature Title t (� {
`'
(over)
DOH-1555 (02/2004)