McDonnell, Ruth Fay NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Ruth Fay McDonnell Female
Date of Death Age If Veteran of U.S.Armed Fo
06/30/2022 92 Years War or Dates
H Place of Death Hospita' ion or
WCity,Town or Village Glens Falls Street A i Glens Falls Hospital
p Manner of Death 0 Natural Cause Accident 1=1Homi id Suicide FlUndetermined ❑Pending
W
C.) Circumstances Investigation
W Medical Certifier Name Title
G William Cleaver MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 345
Burial Date Cemetery,Crematory or Facility Name
07/02/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
8❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
Date Point of
t/)❑Transportation Shipment
Q by Common --.--
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
1=1Rei
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
H Remains are Shipped,If Other than Above
2 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/01/2022 Registrar of Vital Statistics Megan Nolin(Electronically Signed)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance� with this permit on: 1�
Z Date of Disposition 2 222Z. Place of Disposition V ' Ne v.,C L.) e re4,1 q"[T� 3
W /address/ J
W number)
N (section) (lot num r/ (grave
°` nY���� v.qel
GName of Sexton or Person in Cha of Prem. s (please print
Z ` ^�
W Signature / L"' Title (�{ eri r
DOH-1555(o7/ta)p t of 2
1 60 .#
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Represent-mg-the funeral home named on burial permit
Official Funeral Directors Reg. or License#