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Comstock, Ruth Monson NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Ruth Monson Comstock Female Date of Death Age If Veteran of U.S.Armed Forces, 05/21/2021 101 Years War or Dates ., Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation p Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending tL Circumstances Investigation W Medical Certifier Name Title Cl Courtney Diamond NP Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 222 ❑Burial Date Cemetery,Crematory or Facility Name 05/24/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation Z ❑Removal Date Place Removed and/or and/or Held H Hold Address 0 O. Date Point of U) ❑Transportation p by Common Shipment Carrier Destination Date Cemetery Address El Disinterment ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls, New York 12803 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address CC a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/24/2021 Registrar of Vital Statistics qg6ertAndrew Curtis(Electronically Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition !'S—Z5.202.1 Place of Disposition y-1,Q.A f f e) r-e_,,ei, j 2 (address) W CC N (section) \ (lot number) (grave number) O Name of Sexton or Per in C rge of Premises ��-� G%i 3�t z L� z (please print) W Signature Title /2rye a iVry e2 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 31,4 811 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#