Miller Jr., Frank NEW YORK STATE DEPARTMENT OF HEALTH
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Vital Records Section Burial - Transit Permit
• Name First Middle Last Sex
Frank L. Miller,Jr. Male
_,' Date of Death Age If Veteran of U.S. Armed Forces,
a Jul 19,2018 80 War or Dates
)...• Place of Death Hospital, Institution or
Z City Town or Village Granville Street Address Haynes House Of Hope
O Manner of Death 1 XI Natural Cause I I Accident I 1 Homicide Suicide Undetermined Pending
Circumstances Investigation
w Medical Certifier Name Title
Michael R.Bell MD
Address
H HN,Warrensburg,NY 12885
Death Certificate Filed District Number Register Number
City, Town or Village Granville 5756 1-tij
❑Burial Date Cemetery or Crematory
El Entombment September 21,2018 Pine View Crematory
Address
El Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z I I Removal and/or Held
and/or Address
�' Hold
Cl)
O Date Point of
CL u) U Transportation Shipment
a by Common Destination
Carrier
I I Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
.. Remains are Shipped, If Other than Above
• Address
te
1JrJ°
IL' Permission is hereby granted to dispose of the human remains described above as indicated.
• Date Issued 9-20-18 Registrar of Vital Statistics i ViQ�i
(s gnature)
District Number 5756 Place Granville,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition yiil lip Place of Disposition F14 li LI 4 o
2 (address)
W
co
CL (section) (lot number) (grave number)
pName of Sexton or Person in Charge of Premises (r1;t h,,r ¢n.ibt
IZ (please print)
Signature ,% . Title XiAIM_
(over)
DOH-1555 (02/2004)