Miller, Lillian NEW YORK STATE DEPARTMENT OF HEALTH * �
Vital Records Section Burial - Transit Permit
Tigl Name First Middle Last Sex
Lillian Bartley Miller Female
Date of Death Age If Veteran of U.S. Armed Forces,
08/��/2012 82 years War or Dates
Place o eat Hospital, Institution or
y Street Address
IAA City, To fx •ii� X Glens F^ Glcns Its Hospital
Manner c5f"C3eat NI Natural Cause Accident ❑Homicide ❑Suicide unde �rmmed ❑Pending
Iliv Circumstances Investigation
ill Medical Certifier Name Title
Add Christophcr D. Hoy M. D.
s
102 Park Street Glens Falls, N Y 12801
Death Certificate Filed District Number Register Number
City, To x✓� XX Glens Falls 5601 366
'' ❑Burial ate Cemetery or Crematory
❑Entombment Addres 08/02/2012 Pine View Crematorium
lim ECfemation Queensbury, NY 12804
Date Place Removed
Z❑Removal and/or Held
and/or Address
F= Hold
0 Date Point of
Transportation Shipment
C by Common Destination
iiiiiil Carrier
i;ii❑Disinterment Date • Cemetery Address
❑Reinterment Date Cemetery Address
•
Niii Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
jiiiiii Address
402 MapIP StrPPt Saratoga Springs, NY 12866
Pi Name of Funeral Firm Making Disposition or to Whom •
Remains are Shipped, If Other than Above
;' Address
l
Permission is hereby granted to dispose of the human remains described above as indicated.
iiiiiiii Date Issued 08/01/2012 Registrar of Vital Statistics W C~" "4 rL kA-). al
(signature)
District Number Place
iiiM 5601 Glens Fails iili V
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
k
ILI Date of Disposition I-t-lt Place of Disposition .P,,,°(a,) (-tiler iv,.-
2 (addre
tia
CC (section) -(lot number) (grave number)
gi Name of Sexton or Person in Charge of Pr mises iiO3A- , -544
Z (please print)
ill
Signature A Title (►1ocIyr}iTak.-
(over)
•
DOH-1555 (02/2004)