Miller, John Vital Records Section _ ___
Name Firsjohn Middle her rsexMale
Date of Death Age ' If Veteran of U.S. Armed Forces,
07/16/2013 62 years War or Dates _
j- Place of Death Hospital, Institution or
W City, Town or Village Town Of Milton Street Address 2148 Barrett Road
p Manner of Death Q Natural Cause 0 Accident 0 Homicide 0 Suicide 0 Undetermined ri Pending
U111 Circumstances Investigation
ta Medical Certifier Name - Title
G Jenny Romero MD
Ad }rCs a Lane, Saratoga Springs NY 12866
Death Certificate Filed District Number Register Number
t�.4it*Xfown orf Milton 4561 2g
❑Burial 'Date Cemetery o� r Crematory
07/18/2013 Pine-View Crematory
[Entombment Addre
EiCremation uueensbury NY 12804
Date Place Removed
Z D Removal and/or Held
and/or Address
t= Hold
C Date Point of
0 Transportation Shipment
iri by Common Destination
Carrier
0 Disinterment Date Cemetery Address
0 Reinterment _Date Cemetery Address
Permit Issued to Compassionate Funeral Care Reg iftip
Number
Narrie:offuneral Home
Addres 2 Maple Avenue, Saratoga Springs, Ny 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2' Address
DI
Permission is hereby granted to dispose of the ains desc 'bedove as indic ed.
07/17/2013 } �
Date Issued Registrar of Vital S tistic
(signature)
District Number 4561 Place Milton
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
k o
ui Date of Disposition 1-t"1-�3 Place of Disposition �'�la terh.i•.
X (address)
tfi
iM (section) (lot number) (grave number)
C Name of Sexton or Person •n Charge of remises7,,, So,rd}
Z , ( se print)
Signature Title CtirfiliDX
(over)
DOH-1555 (02/2004) -