Wisell, Ruth NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
;:; Ruth L. Wisell Female
i•: Date of Death Age If Veteran of U.S. Armed Forces,
.ern November 13,2014 96 War or Dates
iii Place of Death Hospital, Institution or
` ; City, Town or Village Glens Falls Street Address Glens Falls Hospital
lit
Manner of Death r—toci Natural Cause Accident Homicide Suicide Undetermined Pending
lit Circumstances Investigation
% Medical Certifier Name Title
_ Noelle M. Stevens
e°', Address
.::y 100 Broad St.,Glens Falls,NY 12801
°s Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5''0/ 1/45--- '
❑Burial Date Cemetery or Crematory
November 17, 2014 Pine View Crematory
❑Entombment Address
lI Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
ZZ n Removal and/or Held
and/or Address
H Hold
N
0 Date Point of
N I I Transportation Shipment
p by Common Destination
Carrier
7 Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
a '] Permit Issued to Registration Number
,,_. Name of Funeral Home Alexander-Baker Funeral Home 00037
°r;° Address
: 3809 Main Street,Warrensburg,NY 12885
f:° Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
IX
.�. Permission is hereby ranted to dispose of the human remains des rid/b;i1 a qye a .cated.
` Date Issued // /17 ZO/ Registrar of Vital Statistics /�(�
"e
(signature)
rc* ; District Number 5/a 0/ Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
Date of Disposition II/Il!i1 Place of Disposition ?A L male( -
(address)
W
CL (section) do,„.6
(lot num�r) (grave number)
pName of Sexton or Person in Charge of Premises a'
please print)
W Signature Ar' Title comilp,e,
(over)
DOH-1555 (02/2004)