Paine, Miles ir
I _ ' `, __
NEW YORK STATE DEPARTMENT OF HALTH 3/1e
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Miles E. Paine Male
Date of Death Age If Veteran of U.S. Armed Forces,
04 / 22 / 2016 91 War or Dates 1941-1949
Place of Death Hospital, Institution or
ZCity, Town or Village Saratoga Springs Street Address Saratoga Hospital
ilk Manner of Death rE Natural Cause 0 Accident 0 Homicide 0 Suicide ❑Undetermined 0 Pending
G. Circumstances Investigation
lit Medical Certifier Name Title
Q Carlos A. Ares MD
Address
59 Myrtle St # 300, Saratoga Springs, NY 12866
Oi Death Certificate Filed District Number Register Number
':" City, Town or Village Saratoga Springs
` UBurial Date Cemetery or Crematory
04 / 25 / 2016 Pine View Crematory
iLEntombment Address
Cremation Queensbury, NY
Date Place Removed
Z❑Removal and/or Held
. and/or Address
t Hold
Date Point of
❑Transportation Shipment
a, by Common Destination
Carrier
gi
'? Q Disinterment Date Cemetery Address
lig
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care, Inc 00364
Address
402 Maple Ave. , Saratoga Springs, NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
cc
ILI
Permission is he eby ranted to dispose of the human rem ' or" ed a� indicat .
Date Issued Registrar of Vital Statistics
(signature)
District Number )l Place Saratoga Springs , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 1/u f i, Place of Disposition r11rcL✓ G ra-e-
(address)
iti
tfl
IC (section) (grave number)
0 Name of Sexton or Person in Charge of remises d(lotnumber)
f4*ft, '4V"'
/� (please print) •
10 Signature �✓( Title 6�L
•
(over)
DOH-1555 (02/2004)