Mabie, Ruth NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
i�iMedical
ame First Middle Last Sex
RUTH M. MABIE Female
ate of Death Age If Veteran of U.S. Armed Forces,
March 15, 1999 93 War or Dates none
ace of Death Hospital, Institution or
ty, Town or Village Glens Falls, NY Street Address Glens Falls Hospital
anner of Death ®Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Certifier Name Title
John Dier, MD
Address
102 Park Street Glens Falls, NY 12801
Death Certificate Filed District Number Regist `Number
City, Town or Village Glens Falls, NY 5601 �3
Date Cemetery or Crematory
❑Burial March 19, 1999 Pine View Crematory
Address NY 12804
�sl Cremation Quaker Rd Queensbury,
Date Place Removed
Removal and/or Held
0 and/or Address
Hold
Q Date Point of
N ❑Transportation Shipment _
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to _ Registration Number
Name of Funeral Home Sullivan-Minahan & Potter Funeral Home 01837
Address
407 Bay Road Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose cf the human remains described
ab as' is ted.
Date Issued 3/17/99 Registrar of Vital Statistics
(signature)
District Number 5601 Place
City of Glens Falls, NY 12801
[Name
that the remains of the decedent identified above were disposed of in accordance with this permit on:
Disposition 33- Place of Disposition
(address)
(section) (lot�ber (grave number)
f Sexton or Person in Charge of Premises �'ZWA,Q i � / �[print)
G �/yfre /j? Title '
(over)
DOH-1555 (9/98)
ru ffi-ls -- U-F1
(please print)
Signature Title CP --WA4U --\' iftskx