Ruel, Eileen Marie Y
NEW YORKSTATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Eileen Marie Ruel Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/28/2021 80 Years War or Dates
I,_ Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death Natural Cause ❑Accident ❑Homicide 0 Suicide 0 Undetermined Pending
W
V Circumstances Investigation
QMedical Certifier Name Title
Danushan Sooriabalan MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 317
0 Burial Date Cemetery,Crematory or Facility Name
08/02/2021 Pine View Crematory
❑Entombment Address
0 Cremation Queensbury Town,New York
El Donation
Removal Date Place Removed
and/or and/or Held
N Hold Address
0
a. Date Point of
YnL j Transportation
by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
Address
CC
W
0-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/02/2021 Registrar of Vital Statistics Rp6ert,?ndrewCurtis(E'lectronica1/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:
I-
W Date of Disposition €f T ILI Place of Disposition 1 ,
W ' '(address)
N
0(section) (lot number) (grave number)
13 Name of Sexton or Person in Charge of Pre ' es g 4 s 1N+...,yb
Z (p/e e print)
W Signature Title l�l�Wr'W�12
DOH-1555(o7/18)p t of 2
s•
1
Public Health Law Sec. 4145(2b) 'P'
1
Receipt
1 Human remains of delivered on , 20 ;'
J f�
r._..., Yi r / `lA�- : k._ ,,?*` :'-
Pine View Cemetery Representing'the funeral home name''rl-errt Uri1lIpermit
Official Funeral Directors Reg.or License# I . ,