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Paker, William John #1131 NEW YORKSTATE DEPARTMENT OF HEALTH • h Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex William John Parker Male Date of Death Age If Veteran of U.S.Armed Forces, 10/17/2020 46 Years War or Dates 1993-1996 i_ Place of Death Hospital,Institution or WCity,Town or Village Indian Lake Town Street Address 224 Big Brook Road, Indian Lake Town, New York 12847 p Manner of Death © Natural Cause ❑Accident ❑Homicide El SuicideUndetermined Pending W Circumstances Investigation W Medical Certifier Name Title 0 Matthew Miller Coroner +Address P.O.Box 250, Indian Lake,New York 12842 Death Certificate Filed District Number Register Number City,Town or Village Indian Lake • 2053 11 ❑Burial Date Cemetery,Crematory or Facility Name 10/20/2020 Pine View Crematory EiEntombment Address X❑Cremation Queensbury Town, New York Donation of) ❑Removal Date Place Removed and/or and/or Held l- Hold Address CO 0 a Date Point of co Li Transportation Shipment p by Common Carrier Destination Date Cemetery Address ElDisinterment Date Cemetery Address El Reinterment Permit Issued to Registration Number Name of Funeral Home Miller Funeral Home 01199 Address 6357 Nys Rte#30, Indian Lake,New York 12842 Name of Funeral Firm Making Disposition or to Whom F. Remains are Shipped,If Other than Above 2 Address EC W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/20/2020 Registrar of Vital Statistics Julie A Clawson(Electronically Signed) (signature) District Number 2053 Place Indian Lake, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: L` li--- Z Date of Disposition IU f?o 0.A.TO Place of Disposition W (address) W co cc (section) (lot nu r) (grave number) o Name of Sexton or Person in Charge of Pre ' es ,.....511,tu tr Z (please print)W G-/ . Title [ `(414 96- Signature /^ DOH-1555(07/18)p 1 of 2 • Public Health Law Sec. 4145(2b) 14129 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#