Ruge, Robert Kenneth NEW YORK STATE DEPARTMENT OF HEALTH (1.7,__F)Bureau of Vital RecordsBurial - Transit Permit
Name First Middle Last Sex
Robert Kenneth Ruge Male
Date of Death Age If Veteran of U.S.Armed Forces,
06/29/2022 57 Years War or Dates
1- Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital
p Manner of Death 0 Natural Cause ❑Accident Homicide ESuicide Undetermined El Pending
W
U Circumstances Investigation
QW Medical Certifier Name Title
Enrico Bravo MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed City Of Saratoga Springs District Number Register Number
City,Town or Village 4501 392
Burial Date Cemetery,Crematory or Facility Name
07/01/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
Z❑Removal Date Place Removed
and/or and/or Held
N Hold Address
O
IL Date Point of
(0 ElTransportation
ZS 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
2 Address
CC
W
Il Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/01/2022 Registrar of Vital Statistics ((on Moran(E(ectronica1TySigned)
(signature)
District Number 4501 Place City Of Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition "is-lit Place of Disposition ,IL /Ati---_.
2 ((address)
ILI
U)
8 (section)
_(lot number)C (grave number)
Name of Sexton or Person in Charge of Premises tA r.t 141A4
IZ (p ease print)
Signature a....._ _ — Title IJ (Rip ftiif- t
DOH-1555(07/18)p 1 of 2
4
p .,
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on b9ri4,1-permit
Official Funeral Directors Reg.or License#