Miner, Isabel NEW YORK STATE DEPARTMENT OF HEALTH . .1 �
91-
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
rr Isabel Miner Female
Date of Death Age If Veteran of U.S. Armed Forces,
May 2,2014 90 War or Dates
IPlace of Death Hospital, Institution or
City, or Village Lake George Street Address 2869 State Route 9
Manner of Death Medical Certifier Name
I XI Natural Cause I �y
Accident i Homicide Suicide Undetermined Pending
Circumstances Investigation
Title
Paul Bachman, MD
::K: Address
:xr:
,:e r 3767 Main Street,Warrensburg,NY 12885
,: Death Certificate Filed District Number Register Number
:•r:.: City, Town or Village Lake George,NY _ 5(f)-�--j I , j L9
❑Burial Date Cemetery or Crematory
El Entombment May 5, 2014 Pine View Crematorium
Address
❑x Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z I I Removal and/or Held
and/or Address
t Hold
0 Date Point of
NI 1 Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
I I Reinterment
Date Cemetery Address
fJ? Permit Issued to Registration Number
:V, Name of Funeral Home Regan Denny Stafford Funeral Home 01443
r Address
53 Quaker Road, Queensbury,NY 12804
*: Name of Funeral Firm Making Disposition or to Whom
I""r Remains are Shipped, If Other than Above
r
Address
:
;rti Permission is hereby granted to dispose of the human remains escribed above as indicated.
rrj r Date Issued SJ S/I LT Registrar of Vital Statistics _ U-L
�{ (signatur
r District Number S(ag Place Lake George,NY
f:
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
1
Ili Date of Disposition S It,IN Place of Disposition ": ��,.r,� `
W (address)
Cl)
pr (section) � -(lot numbs (grave number)
Name of Sexton or Perso in Charge f Premises 1k ,{ . l�7 � oar
Z (please print)
til
Signature (._. Title Cer ritp i..
(over)
DOH-1555(02/2004)