Noyes, Ruth NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
RuthWNoyes F
_7
Date of Death Age If Veteran of U.S. Armed Forces,
1-26-98 91 War or Dates NA
Place of Death Hospital, Institution or
City, Town or Village Ft.Edward Street Address Ft. Hudson NH
Manner of Death 0 Natural Cause Accident Homicide ❑Suicide ❑Undetermined El Pending
Circumstances Investigation
Medical Certifier Name Title
Dr. Vill 'uan MD
XX
Address
Glens Falls, NY
Death Certificate Filed District Number Register Number
City, Town or Village Ft. Edward 5755
Date Cemetery or Crematory
❑Burial 1-27-98 Pine View Crematory
Address
❑x Cremation Queensbury, NY
Date Place Removed
oF Removal and/or Held
••• and/or Address
Hold
0 Date Point of
Q Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
-Fteinterment-- Date- Cer ietery-Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker FH 00022
Address
Warrensburg, NY
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 humai remai escri ove as indicated.
> , Date Issued 1-27-98 Registrar of Vital Statistics
- �
(sig atur
District Number 5755 Place T/0 Ft. Edward
I certify that the remains of the decedent identified above were disposed of in accordancewith this permit on:
Date of Disposition;�" - Place of Disposition _P11A1)G7 f� l�J � 72x /�� �/ C�
(address)
iU
( ection) lot nu ber (grave number)
GName of Sexton or Perso in Charge of Premises `'
g (please print
Signature Title �i /� 4 �/ /
DOH-1555 (10/89) p. 1 of 2 VS-61