Ritchie, Howard 4i (t3
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
_First
aid 9lLwit4 1?1tTCH1 . M
Date of Death Age If Veteran of U.S. Armed Forces,
0 9 1 Z"7 1 i i '{b War or Dates
W. Place Bath Hospital, Institution or For+ • {SOrt NCB
City, own r Villagebrt £cltNa.rd Street Addresslij 319 groarrva ut
• Manner of Death Natural Cause El Accident El Homicide ❑Suicide El Undetermined ❑Pending
ICE Circumstances Investigation
tu Medical Certifier Name Title
Et leer .S?i,r,e,lCt A N? - C
Address
q (ctre ?Id. , C_�tueens , N1 I Z7U4
Death Certificate Filed ,y District N mber Regist r umber
City, Town or Village .�5 1p�
>i` ❑Burial Date Cemetery or Crematory
❑Entombment 09/29/2014 Pine View Crematorium
Address
:::Cremation Quaker Rd., Queensbury, New York 12804
Date Place Removed
Removal and/or Held
2 and/or
Address�
Hold
C —
0 Date Point of
05 El
Transportation Shipment
6 by Common Destination
•
Carrier
❑Disinterment Date Cemetery Address
El Reinterment Date ' Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Ct,r reky1 -h. er&( J4yrte iiit_C_. 00 y7c-,
Address ,/I p�
(0 O ckl� $-L. - \ cisuai ¶ c f NIY 121 39
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
It
III —
c` Permission is ereb granted to dispose of the human remains described ab ve as'ndicated.
Date Issued Registrar of Vital Statistics k
(signature)
District Number 5� sc., Place 1 (YZAM- Ot 7C, Ci
• I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
iii Date of Disposition 10 I i I pi Place of Disposition ',nva f w-tdr,,..
2 (address)
LEI
U)
CC (section) 7 (lot number (grave number)
0 itName of Sexton or Person in Charge of Premises c �atq�- gel
2 (plebse print)
14 Rli, Si C��gnature 1 4 Title G k
(over)
DOH-1555 (02/2004)