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Miller, George NEW YORK STATE DEPARTMENT OF HEALTH i `t 47 I Z l Vital Records Section Burial - Transit Permit Name First Middle Last Sex George Miner 0ehzy Miller Male Date of Death Age If Veteran of U.S. Armed Forces, February 22, 2018 68 War or Dates Vietnam Place of Death Hospital, Institution or T. City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death 0 Natural Cause D Accident ❑ Homicide ❑ Suicide Undetermined ❑ Pending Circumstances Investigation Medical Certifier Name Title John Agresta, Address Death Certificate Filed District Number Register Number City, Town or Village j 6 O j 10 0 Burial Date Cemetery or Crematory February 26, 2018 Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Remqved ❑ Removal and/or Held and/or Address Hold Date Point of ❑Transportation Shipment by Common Destination Carrier Date Cemetery Address ❑ Disinterment ❑ Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above . Address if Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 7j 2.L 120 i lc Registrar of Vital Statistics lrU Ct,L .U).A.AsS (signature) District Number 5 6©) Place 6 CAS Tut\S; Al ' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 02/26/2018 Place of Disposition Quaker Road Queensbury,NY 12804 (address) Tr (section) (lot numb (grave number) 0 Name of Sexton or Person in Charge of Premises 4._,Tif,_ ...at/I� lease pent) Signature (� /4 Title MA !_ (over) DOH-1555 (02/2004)