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Knoblock, Ruth Harvey C1-.17. .....fl NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Ruth Harvey Knoblock Female Date of Death Age If Veteran of U.S.Armed Forces, 01/07/2024 97 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Moreau Town Street Address 198 Bluebird Road,Moreau Town, New York 12903 LU p Manner of Death a Natural Cause Accident III Homicide DSuicide FlUndetermined El Pending W Circumstances Investigation W Medical Certifier Name Title f7 Madison Zuis NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Moreau District Number Register Number City,Town or Village 4562 3 HBurial Date Cemetery,Crematory or Facility Name 01/09/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held pN Hold Address 0 Date Point of V)❑Transportation Shipment s by Common Carrier Destination IDDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 • Name of Funeral Firm Making Disposition or to Whom i— Remains are Shipped,If Other than Above a Address Q IW a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/08/2024 Registrar of Vital Statistics Brenda?futter(E(ectronicalfySigned) (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 I—' -.3_,,,-, Place of Disposition Pine, V;C,A) G CCr C1 fY UJ 2 (address/ W N CC (section/ (lot number) (grave number/ GName of Sexton or Person in Charge of Premises c�-<-r m ('Y SE.,),"-3 Z ` (please print) ,�✓ Title r W Signature Gfe r� G .,,e,, DOH-1555(07/18)p 1 of 2 1 a P 3 1, 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#