Miller, Rosemary NEW YORK STATE DEPARTMENT OF HEALTH #
Vital Records Section Burial - TransiP�err�it
Name First Middle Last Sex
Rosemary D. Miller Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/06/2013 85 War or Dates No
I— Place of Death Hospital, Institution
Z City ,Town or Village City of Albany or Street Address Albany Memorial Hospital
0' Manner of Death ® Natural Undetermined ❑ Pending
W Cause Accident ❑ Homicide Suicide ❑
Circumstances Investigation
W Medical Certifier Name Title
0 Riaza Mirza MD
Address
63 Shaker Road Albany, NY 12204
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 1296
Date Cemetery or Crematory
❑ Burial 07/09/2013 Pine View Crematory
0 Entombment Address
® Cremation
Queensbury, NY
Z Date Place Removed
Removal and/or Held
Q 0 and/or Address
Hold
CO
Transportation Date Point of
Ct.N' ❑ By Common Shipment
8 Carrier Destination
❑ Disinterment
Date Cemetery Address
Date Cemetery Address
❑ Reinterment
Permit Issued To Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Avenue Saratoga Springs, NY 12866
I—, Name of Funeral Firm Making Disposition or to Whom
,..' Remains are Shipped, If Other than Above
gg,, Address
L±
d- Permission is hereby granted to dispose of the human remains described bove as indicated.
Date 07/09/2013C C
Issued Registrar of Vital Statistics L�Q�
(signature) c U
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accord
with this permit on:
Z` Date of Disposition "Z-tn`t3 Place of Disposition )46++,.1 ll c t...
w` (address)
2
w
co
0
(section) (lot tuber) (grave number)
ZName of Sexton or Person in Charge of Premises 1 i ., JN�
(please print)
Signature durly__ Title CacillAtot
(over)
DOH-1555 (02/2004)