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Fitzgerald, Ruth NEW YORK STATE DEPARTMENT OF HEALTH 4 0., 5S Vital Records Section Burial - Transit Permit ii; Name First Middle Last ini t4 � N e F' SF V"1 A,LA C._ r I c c c L A o >." Date of Death Age,„ i If Veteran of U.S. Armed Forces, "'" 0 I I f -O I s I -1' i War or Dates `l! Place of Death ! Hospital, Institution or City, Town or Village C LENS FALLS Street Address (�LC I.-1 S �A(.�-S ���s1'LT to L Manner of Death®Natural Cause Accident Homicide Suicide n Undetermined Pending 41 Circumstances Investigation a Medical Certifier Name Title ti N A IA 0 A 4,rnC1) In g Address f$� t©6 �'A��L S-C v L�r-�S V-A C.C.S ,►-3'-� t' ° 1 4"' Death Certificate Filed l District Number 1 Register Number 37 is City, Town or Village 6 LE I)S cP.L.L.S ! S-6 O t Date 1 a' (/ I Cemetery or Crematory ❑: Burial (7 1 a.©t.S I P 1 v.e_ �:.., L c c_,,...G Address :::> ®Cremation Qv,L.Q.c 2„ �e�„,S�v r k i tJL t a_ciA9 Date Place Removed x a Removal and/or Held tt and/or Address - -- Hold CD 9. I Date Lint of it 0 Transportation j Shipment a by Common Destination — Carrier 0 Disinterment Date Cemetery Address Reinterment Date Cemetery Address ' > Permit Issued to Registration Number Name of Funeral Home!`JCL/na ram' V: kec Funeral neral home. 01 I `'�' Address li La-rajc-cfc Of / &(A St-9 i AJUO 9oc)t JaYGy !:' Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above 410 Address rg ALI i Permission is hereby y granted to dispose of the human,+emains d cribed ove as in cat II Date Issued()I .-c Registrar of Vital Statistics ?d Q7 lie ::' (si re) eta;; - -A �/ f District Number Place ��, `� im I certify that the remains of the decedent identified above were disposed of in accordant with this permit on: f= Date of Disposition I-Zl-I S Place of Disposition l'n,u' .., e7A-J- 2 (address) th EC (section) t numb (grave number) AName of Sexton or Person in Ch ge of Premises to 3a+u(5- A (please print) Signature Title C y 1 (over) DOH-1555 (9/98)