Brewster, Ruth May , LF)r -
NEW YORK STATE DEPARTMENT OF HEALTH (1
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Ruth May Brewster Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/23/2022 93 Years War or Dates
F. Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address Warren Center for Rehabiwtation and Nursing
UJ Manner of Death El Natural Cause DAccident Homicide OSuicide ❑Undetermined Pending
V Circumstances Investigation
E Medical Certifier Name Title
Wendy Steinhacker PA
Address
42 Gurney Ln,Queensbury Town,New York 12804
Death Certificate Filed Town or Queensbury District Number Register Number
0,Town or 565
7 80
Burial Date Cemetery,Crematory or Facility Name
Addre20t2 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
DDonation
0❑Removal Date Place Removed
and/or and/or Held
NHold Address
0
O. Date Point of
N❑Transportation
a by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
ElReinterment 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
f.. Remains are Shipped,If Other than Above
S Address
Q
W
CL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/25/2022 Registrar of Vital Statistics Camine.7fi!gank Bartarer(E/ectronicafySti
(signature/
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IH
Z Date of Disposition LI IZial Zi Place of Disposition 471,101. +� _74;0 ro—
W (address)
W
COC (section) (lot number/ (grave number)
SName of Sexton or Person in Charge of Pre ises h 4JWease1--, ti print/
W Signature ZL----- Title CofAxi 2
g
DOH-1555(o7/18)p 1 of 2
' 0 1.60O0
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 Reg. or License#