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Gilman, Ruth Mary
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Ruth Mary Gilman Female Date of Death Age If Veteran of U.S.Armed Forces, 08/03/2021 101 Years War or Dates f.. Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital tL Manner of Death Undetermined Pending W © Natural Cause Accident ❑Homicide Suicide ❑ ❑ Circumstances Investigation W Medical Certifier Name Title David Cunningham MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 325 ❑Burial Date Cemetery,Crematory or Facility Name 08/06/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation Z ❑Removal Date Place Removed and/or and/or Held Hold Address 0 a.U) ❑Transportation Date Point of p by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 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 08/05/2021 Registrar of Vital Statistics WgbertAnrfrew Curtis(Efectronica[Cy 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 gI�('i,1 Place of Disposition �� 2 (address) W CC CC (section) of number) (grave number) ia • Name of Sexton or Person in Charge of Premises kti +�� Z (please rint) W Signature Title DOH-1555(07/18)p t of 2 f ; Public Health Law Sec. 4145(2b) Receipt Human remains of `` ` ' delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors keg. or License#