Patton, Ruth I
EW YORK STATE DEPARTMENT OF HEALTH it 170
If _ Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Ruth H. Patton Female
Date of Death Age If Veteran of U.S. Armed Forces,
February 27, 2012 92 War or Dates
Place of Death Hospital, Institution or
I City, Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc.
Manner of Death Li Natural Cause El Accident 0 Homicide 0 Suicide IEl I Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Rick D Teetz, Dr.
Address
131 Lawrence Street Saratoga Springs, NY 12866
Death Certificate Filed District Number RegirDumber
,,,,,)i;. City, Town or Village
7 0 Burial Date Cemetery or Crematory
March 1, 2012 Pine View
w '0 Entombment
lt Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
rys Removal and/or Held
and/or Address
Hold
Date Point of
', 0 Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
0 Reinterment
Date Cemetery Address
4 Permit Issued to Registration Number
Z.S4!: Name of Funeral Home M.B. Kilmer Funeral Home 01078
coi
Address
x
136 Main Street, South Glens Falls NY 12803
14
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
` Address
-t ,
Permission is hereby granted to dispose of the human remai desc b abovas i i ated.
Date Issued OZ(74Z0
Z Registrar of Vital Statistics
(signature)
District Number L.15O Place e 'A,,k CA- S at.1 X ct ()"r.s:S
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
° Date of Disposition 03/01/2012 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) (lot number) (grave number)
Name of Sexton or P rson in Charge f Premises c L,A4 J l"4t
(please print)
Signature Title CiZ V
(over)
DOH-1555 (02/2004)