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Homestead, Ruth E 4iyZ NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Ruth E.Homestead Female Date of Death Age If Veteran of U.S.Armed Forces, 01/25/2021 92 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing p Manner of Death ©Natural Cause ❑Accident ❑Homicide E]Suicide LiUndetermined Pending V Circumstances Investigation W Medical Certifier Name Title Roslyn Socolof MD Address 42 Gurney Ln,Queensbury Town, New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 27 ❑Burial Date Cemetery,Crematory or Facility Name 01/25/2021 Pine View Crematory ❑Entombment Address Cremation Queensbury Town,New York ElDonation 0 Removal Date Place Removed and/or and/or Held H Hold Address to 0 O. Date Point of �f) Transportation p by Common Shipment Carrier Destination Date Cemetery Address ❑Disinterment Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500,Lake Luzerne,New York 12846 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above a Address W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/25/2021 Registrar of Vital Statistics Caroline Hildegarde Barber(Electronically Signed) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IF- Z Date of Disposition )J t,itl Place of Disposition a� IL 2 (address) W CC N (section) (lot tuber) (grave number) O Name of Sexton or Person in Charge of Premise / Z (please pril!) tU Signature Title r "Kirre DOH-1555(07/18)p id 2 f ' Public Health Law Sec. 4145(2b) ° 45 8 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#