Miller, Margaret Maryland Burial Transit Permit
This permit must accompany remains to destination
File Number
1.Decedent's Name,AKA Name(if any) 2.Date of Death 3.Time of Death
MARGARET MILLER 02/06/2017 0450
4a.Facility Name 4b.City,Town or Location of Death 4c.County of Death
HOMEWOOD AT CRUMLAND FARMS FREDERICK FREDERICK
5.Social Security Number 6.Sex 7.Age 8.Date of Birth 9.Birthplace
056220049 F 88 YR 08/16/1928 NEW YORK
Usual Residence of Decedent 10b.County 10c.City,Town or Location 10d.Inside City Limits?
10a.StateMARYLAND FREDERICK FREDERICK NO
10e.Address7407 WILLOW ROAD 10f.Zip Code 21702
11. Marital Status 12.Ever in U.S. 13.Hispanic Origin? NO 14.Race
WIDOWED(AND NOT Armed Forces? WHITE
REMARRIED) NO
15.Decedent's Education 16a.Decedent's Usual Occupation 16b.Business/Industry
SOME COLLEGE HOMEMAKER DOMESTIC
17. Father's Name 18.Mother's Name Prior to First Marriage
ROY FOX DORIS WETERMAN
19.Surviving Spouse's Name
20a.Informant's Name 20b.Informant's 20c.Informant's Mailing Address
JEFF MILLER Relationship 18524 MOUNTAIN LAUREL TERRACE,GAITHERSBURG, MD
SON 20879
21a.Method of Disposition 21b.Place of Disposition 21c.Date of Disposition 21d.Location
BURIAL PINEVIEW CEMETERY 02/09/2017 53 QUAKER ROAD,QUEENSBURY, NY
12804
22a.Signature of Funeral Service Licensee 22b.License No 22c.Name and Address of Funeral Facility
MICHAEL P MARZULLO E M00407 MARZULLO FUNERAL CHAPEL, P.A.
6009 HARFORD ROAD, BALTIMORE, MD 21214
Authority for Burial,Transportation, Removal, Cremation or Other Disposition
This burial permit,when completely filled in and bearing below the signature of the attending physician and funeral director,constitutes authority for burial,
transportation,removal,cremation or other disposition of the deceased named above.
Cemetery or Crematory Authority Shall Fill Out Section Below
The deceased named above was
X buried
-; cremated
in the cemetery or crematory named in item 21 b.
Burial was in Section Unadi l la Ext. Lot 28A Grave 3
Signature(Sexton or other person in charge)(1AllaC,t',L i � Date Signed 2/1 0/1 7
This burial transit permit must be signed above by the cemetery rematory authority. Where there is no full-time person in charge of the cemetery,the
funeral director may sign as the sexton.
If burial took place in Maryland,this permit must be returned within ten days to the:
Maryland Department of Health and Mental Hygiene
Division of Vital Records
6550 Reisterstown Road
Baltimore,Maryland 21215
29a.Certifier Type 29b.Signature and Title of Certifier M 29c.License No 29d.Date signed
CERTIFYING PHYSICIAN SIBTE ABBAS KAZMI, MEDICAL DOCTOR - D47951 02/06/2017
30a.Name of person who completed cause of death 30b.Address of person who completed cause of death
SIBTE ABBAS KAZMI 814 TOLL HOUSE AVENUE, FREDERICK, MD 21701
For Office Use Only:
31.Date Filed 32.Registrar at Filing 33.Date Issued 34.This is to certify that this is a true and correct copy of the official record on file in
the office of the Maryland Division of Vital Records.
Registrar's Signature