Miller, Marion NEW YORK STATE DEPARTMENT OF HEALTH , _.. 11
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Marion King Miller Female
•
Date of Death Age If Veteran of U.S.Armed Forces,
I. February 3, 2006 88 War or Dates
2 Place of Death Hospital, Institution or
W City, Town, or Village Queensbury Street Address The Landing Of Queensbury
G Manner of Death El Natural Cause ❑ Accident ❑ Homicide (Suicide ❑ Undetermined ❑ Pending
W Circumstances Investigation
U Medical Certifier Name Title
W Suzmoi E Hit• &LooD of D . .
0 Address
14 I tith12 ,bNrvG a csa , AI /2.8° - •
Death Certificate Filed District Num1.6er Regisl Number
City, Town or Village Queensbury 6(L 1
❑Burial Date Cemetery or Crematory
February 6, 2006 Pine View Crematorium
❑ Entombment Address
ElCremation Quaker Rd. Queensbury, NY 12804-
Z Date Place Removed
0 n Removal and/or Held
- and/or Address
Hold
0 Date Point of
0 ❑Transportation Shipment
O. by Common Destination
Carrier
Date Cemetery Address
a ❑ Disinterment
❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton-Healy Funeral Home 0/G 8g,
Address
407 Bay Road, Queensbury, New York 12804
~ Name of Funeral Firm Making Disposition or to Whom
2 Remains are Shipped, If Other than Above
X
W Address
0.
Permission is hereby granted to dispose of the human remaigs describ Nce s indi ated.
Date Issued a (p-O(o Registrar of Vital Statistics I �Lk_.-J
L.....P Lsi(
\---. (signature)
District Number C 1,c `l Place Queensbury,New York
P I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 02/06/2006 Place of Disposition Pine View Crematorium
2 (address)
W
It (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises Cy--tk.Z N. Z. - (\1 A `
2 , (please print) ij
W Signature C g A —( lt-RA Nc Title c��, la-in 6'f-' (�'
T` (over)
DOH-1555 (02/2004)