Karpeles,Ruth Margaet it 911
47
NEW YORK STATE DEPARTMENT OF HEALTH ) Burial - Transit Permit
Bureau of VitaL Records
Name First Middle Last Sex
Ruth Margaret Karpeles Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/06/2022 93 Years War or Dates
i_ Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address 390 Church Street, Saratoga Springs, New York 12866
0 Manner of Death ❑X Natural Cause Accident ❑Homicide OSuicide FlUndetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
O Mirabelle Beck NP
Address
394-402 Church Street,Saratoga Springs,New York 12866
Dea9th Certificate Filed City Of Saratoga Springs District Number Register Number
City,Town or Village 4501 720
Burial Date Cemetery,Crematory or Facility Name
12/09/2022 Pine View Crematory
Entombment — — — -- — ——— — — —— .— — --- _...—_ ---
Address
Cremation Queensbury Town,New York
IIIDonation
ZO❑Removal Date Place Removed
and/or and/or Held
N Hold Address
CO
0
IL Date Point of
CO Dransportation Shipment
0 by Common
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
1— Remains are Shipped,If Other than Above
2 Address
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/09/2022 Registrar of Vital Statistics Tillon Moran(/ctwnicaf Srgned
(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:
I—
Date of Disposition 11,iZ (71 Place of Disposition ,4 k`�,,. di'--------
2 (address)
W
N (section) (lot number) (grave number)
°� 0n rt
8 Name of Sexton or Person in Charge of Premises �
J lease print)
W Signature �— Title C1ZFm�
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
1
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# •