Ritter, Pauline tt
NEW YORK STATE DEPARTMENT OF HEALTH Transit���
Vital Records Section Burial ermit t
Name First Middle Last Sex
Pauline Ritter Female
Date of Death Age If Veteran of U.S. Armed Forces,
January 6, 2014 + 1 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
• Manner of Death Natural Cause ❑Accident n Homicide ❑Suicide n Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
Frances Bollinger MD
Address
100 Broad St,Glens Falls,NY 12801
Death Certificate Filed District Numbe5.F6 1 Register Number
City, Town or Village Glens Falls �./6ol /3
❑Burial Date Cemetery or Crematory
January 8, 2014 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
ZZ n Removal and/or Held
and/or Address
H Hold
N
O Date Point of
n Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
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
i- Remains are Shipped, If Other than Above
2 Address
W
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued ! / /14' Registrar of Vital Statistics WC \..9-
(signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
U
w Date of Disposition I M Place of Disposition jti 3tV)
r2 (address)
W
N
(section) (lot nu�r) (grave number)
0p Name of Sexton or Person in Charge ppf Premises ,,tt(v
�� P release print)
Signature 1, ILCL�_ Title 621attitTen
(over)
DOH-1555(02/2004)