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Neubert, Viola NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit ii0, Name First Middle Last Female �'>� r>` Viola Neubert ti Date of Death 1 Age If Veteran of U.S. Armed Forces, fi 03/26/2011 i 9-6 War or Dates �" Place of Death Hospital, Institution or Crown claiiilinlik Indian Lake Street Address 168 Sabael Road Manner of Death 7 Natural Cause Accident 0 Homicide Suicide ❑Undetermined ❑Pending , Circumstances Investigation -„. Medical Certifier Name Title Dr. Daniel Way MD :n. Address Wit, Indian Lake,NY Vr Death Certificate Filed District Number Register Number ``] Indian Lake �© S 3 i Town t � , Date Cemetery ofCrematory Burial 03/28/2011 Pine View CreCrematory Address ®Cremation Queensbury, NY Date Place Removed o Removal 1 and/or Held P!. and/or. Address 8,�'" Hold Date Point of %❑Transportation 1 ( Shipment 5 by Common . Destination Carrier 1 <:..: Disinterment Date ' Cemetery Address Li 0 Reinterment Date ' Cemetery Address VI Permit Issued to 1 Registration Number '" Name of Funeral Home Miller Funeral Home 1 01222 11: Address t�l 35 W. Main St, PO Box 718, Indian Lake, NY 12842 Name of Funeral Firm Making Disposition or to Whom ' " Remains are Shipped, If Other than Above Address 1 Permission is ereby granted to dispose of the hums sins describ ayoye as indicated.'' �>{<l Date Issued 3 gtJ 1?r)t! Registrar of Vital Statistics �� 2 . (ssii nature) I dal- ----- . t; District Number g(.�5� Place acts�.=n I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H Date of Disposition 3 3v'11 Place of Disposition ►a;<�.► Cr <1a 1�� (address) f (section) / ii(lot nu r) (grave number) 0 Name of Sexton or Pe on in Charlie of Premises C r,s# M r b lt+ 2 j (please print) /, Title CV Erg � Signature l �'r� it.'k, 414— DOH-1555 (10/89) p. 1 of 2 VS-61