Demarsh, Ruth Elizabeth ilD # YR.
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Ruth Elizabeth Demarsh Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/03/2022 97 Years War or Dates
i_ Place of Death Hospital,Institution or
Z City,Town or Village Moreau Town Street Address 14 Sweenor Lane,Moreau Town,New York 12831
W W Manner of Death Undetermined Pending
Natural Cause Accident Homicide Suicide
U
Circumstances Investigation
W Medical Certifier Name Title
0 Anne Evans DO
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed Town Of Moreau District Number Register Number
City,Town or Village 4562 23
Burial Date I Cemetery,Crematory or Facility Name
® 05/04/2022 I Pine View Crematory
Entombment Address
['Cremation Queensbury Town,New York
Donation
c❑Removal Date Place Removed
and/or and/or Held
l— Hold Address
N
0
Date Point of
to❑Transportation Shipment
p by Common
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
Reinterment
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
g Address
CC
W
II' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/04/2022 Registrar of Vital Statistics Leeann Mc cabe(Electronically Signed)
(signature)
District Number 4562 Place Town Of Moreau
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Il— ,j-.
Z Date of Disposition ejjjZZ Place of Disposition e iJ e (Jo'ea.) r-4. )t
W (address/
IJ 1 (lo umber) (grave number)
U) (section)IX //
G Name of Sexton or Person in Charge of emisesIS) �/
please print)
z
W Signature
oii Title
DOH-1555(07/18)p 1 of 2
r
11 5 ?
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#