Miner, Michael 1 4 - 7o
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
gY Name First Middle Last Sex
Michael Miner Male
Date of Death Age If Veteran of U.S. Armed Forces,
09 / 21 / 18 56 War or Dates N/A
Place of Death Hospital, Institution or
WCity, Town or Village Saratoga Springs Street Address 252 Ballston Road
Q Manner of Death v. Natural Cause 0 Accident Homicide Suicide �Undetermined �Pending
Circumstances Investigation
tu Medical Certifier Name Title
Q Daniel J. Kuhn Coroner
Address
40 McMaster Street, Ballston Spa., NY 12020
Death Certificate Filed District Number Register DI er
iim
City,Town or Village Saratoga Springs b
< .ElBurial Date Cemetery or Crematory
mii 09 / 24 / 2018 Pine View Crematory
iiM['Entombment Address
i OCremation Queensbury, NY
Date Place Removed
Z❑Removal and/or Held
2 and/or Address
t Hold
CA
0 Date Point of
Transportation Shipment
8 by Common Destination
Carrier
m Q Disinterment Date Cemetery Address
Q Reinterment Date ' Cemetery Address
Permit Issued to ' Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave., Saratoga Sp., NY 12866
iiIiig Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
ttr
LEI
Permission is he by ranted to dispose of the human rem ' cri d a indicate .
;> Date Issued ' + Registrar of Vital Statistics
(signature)
District Number 'b\ Place Saratoga Springs , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
10 Date of Disposition 111S h Place of Disposition e,g1�.. Lrr-*c,-(or,-„
2 (address)
III
tr (section) Alot number) (grave number)
Name of Sexton or Person in Charge of Premises ( 11tut i sr• ,SoitA'fr
/, / (pleas print) .
to Signature j/�'/ /'-",� Title Pk.AM 1 fl/l..
(over)
DOH-1555 (02/2004)