Duffany, Ruth ` j
NEW YORK STATE DEPARTMENT OF HEALTH k 2144
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Ruth G. Duffany Female
Date of Death Age If Veteran of U.S. Armed Forces,
April 25,2014 90 War or Dates
Place of Death Hospital, Institutiordirondack Trii-County Health Care
, : City, Town or Village Johnsburg Street Address Center
Manner of Death x Natural Cause Accident Homicide Suicide Undetermined Pending
113 Circumstances Investigation
w Medical Certifier Name Title
F ; Thomas Warrington
Address
HH IN,Johnsburg,NY 12843
Death Certificate Filed District Number Register Number
City, Town or Village Johnsburg 5655 1
❑Burial Date Cemetery or Crematory
April 28,2014 Pine View Crematory
❑Entombment Address
❑X Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
52 and/or Address
H Hold
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0 Date Point of
O.
Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the huma •ins describe above indicated.
)_ J
Date Issued 4- e)to, / Registrar of Vital Statistic.
(signature
District Number 5655 Place Johnsburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
w Date of Disposition 11/111 ,i Place of Disposition AL (r.wtael,..,
W (address)
CO
CL (section) �� - (lot numr) (grave number)
p �,Name of Sexton or Person in Charge of Premises , eh+31t
LZ please print)
Signature Title CeVictlE(L
1
(over)
DOH-1555 (02/2004)