Dumas, Ruth Carol. iS
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit PermiCL:F.'N' #
Bureau of Vitat Records
Name First Middle Last Sex
Ruth Carol Dumas Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/09/2022 90 Years War or Dates
i_ Place of Death Hospital,Institution or
Z City,Town or Village Moreau Town Street Address 97 Spier Falls Road,Moreau Town,New York 12831
W Manner of Death n I I g
� I I Natural Cause Accident �Homicide EllSuicide Undetermined Pending
Ili Circumstances Investigation
U
W Medical Certifier Name Title
'n Mark Quaresima MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Moreau District Number Register Number
City,Town or Village 4562 62
HBurial Date Cemetery,Crematory or Facility Name
12/13/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
Z Removal Date Place Removed
❑- and/or and/or Held
II—- Hold Address
0
+d Date Point of
(I) Transportation Shipment
p by Common
Carrier Destination
El
Disinterment
Date Cemetery Address
111 Reinterment Date Cemetery Address
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
1- Remains are Shipped,If Other than Above
2 Address
CC
ill
CL
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/12/2022 Registrar of Vital Statistics Leeann McCabegkctronicaf 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:
I—
Z Date of Disposition 12114 (72_ Place of Disposition `ruA
LU
2 (address)
W
Cl) (section) 46(lofnumber) i l (grave number)
O• Name of Sexton or Person in Charge of Premises le a print) t
(P
W Signature Title �� �C
DOH-1555(07/18)pi of 2
t...) 8
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#