Miller, Kathryn f v,. 4 3'ir
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First rcaMiddlelegr Seemale
Date of Death Age If Veteran of U.S. Armed Forces,
• 05/10/2015 89 years War or Dates
1- Place of Death Hospital, Institution or
ZANK45 Town ontiMejfe Malta Street Address Home Of The Good Shepherd
Ja
Manner of Death EiD1 Natural Cause 0 Accident 0 Homicide El Suicide 7Undetermined �Pending
t Circumstances Investigation
tu Medical Certifier Name Title
Marc Price M D
d
Oshoute 9, Suite 200, Mechanicville, N Y 12118
Deati?Certificate.Filed _ District Number Register Number
Town Of Malta 4560_ 2
Town o�� _
<s'>CI Burial Date Cemetery or Crematory
05/11/2015 Pine View Crematory
❑Entombment Address •
Cremation Queensbury, New York 12804
Date Place Removed
f n Removal and/or Held
and/or
Address
Hold
' Date Point of
titi❑Transportation Shipment
G by Common Destination
Carrier
L_.I Disinterment Date Cemetery Address
r Reinterment Date Cemetery Address
Permit Issued to Reggis#ration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address .
402 Maple Ave, Saratoga Springs, NY 12866
>4 Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address .
0. Permission is hereby granted to dispose of the human remains described above as indicated.
issued 05/12/2015
Date I •
Registrar of Vital Statistics 4170 $
(signature)
District Number Place Town Of Malta
[certify that the,'remains of the decedent identified above were disposed of in accordance with this permit on:
1' Date ofg (i 9,...a
Disposition 5 J�3jfs Place of Disposition ioi
(address)
• ' (section) (lot number) (grave number)
t Name of Sextorh or Person in Ch rge of Premises Al'` �trot-
(p ase print)
Signature w . ` Title
• fft " AEI
(over)
DOH_1555 (02/200.4)