LaFera, Ruth NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Ruth Theresa LaFera I Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/20/2022 97 Years Waror Dates
F Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address 30 Second Street,Glens Falls,New York 12801
W Manner of Death ❑Undetermined �Pendin Lu x Natural Cause 1:1Accident 1:1Homicide Suicide g
W Circumstances Investigation
W Medical Certifier Name Title
Mary Stein NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 221
X Burial Dale Cemetery,Crematory or Facility Name
0 4/2 612 0 2 2 St.Alphonsus Cemetery - --- -
Entombment Address
❑Cremation Queensbury,New York
Donation
Z Removal Date Place Removed
H and/or and/or Held
to Hold Address
O
a Date Point of
CO❑Transportation
O by Common Shipment
Carrier Destination
❑Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
i— Remains are Shipped,If Other than Above
9 Address
W ---.------ -
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/22/2022 Registrar of Vital Statistics Wegan.Norin('ECectronicaQy Signed
(signalum)
District Number 5601 Place City Of Glens Falls
I certify that the remains of th decedent identified above were disposed of in accordance with this permit on:
F 1
W Z Date of Disposition Place of Disposition . f'i�YISGs I(, Lot bG
/a ress/
Lu
/section/ /! umber (grave number/
C3 Name of Sexton or Person i Charge of Premises
Z f � (pleaseprin!/
W Signature � Title
DOH-1555(07/18)p 1 of 2