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Mills, Paul Francis A Io'b 4 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Paul Francis Mills Male Date of Death Age If Veteran of U.S.Armed Forces, 09/27/2020 52 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Town Street Address 161 Duer Road,Fort Edward Town,New York 12828 p Manner of Death Undetermined Pending © Natural Cause 0 Accident n Homicide 0 Suicide W Circumstances Investigation W Medical Certifier Name Title CI Gerard Abess MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 80 ❑Burial Date Cemetery,Crematory or Facility Name 10/05/2020 Pine View Crematory ElEntombment Address X❑Cremation Queensbury Town,New York ❑Donation g El Removal Date Place Removed and/or and/or Held N Hold Address 0 Q. Date Point of (/) L j Transportation Shipment ES by Common — Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom {-- Remains are Shipped,If Other than Above Address CC In a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/01/2020 Registrar of Vital Statistics Aimee Mahoney(ECectronically Signed) (signature) District Number 5755 Place Fort Edward, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:((// I— Z Date of Disposition /0 I O D Place of Disposition i.t l�f,.., 2 (address) W CC (section) (grave number) Name of Sexton or Person in Chargises ,Ionumber) tt., , J **Z (plprint) p1 ax Signature Title L� +� g DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 1 4 ' Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on;burial permit Official Funeral Directors Reg.or License# ' -