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King, Eleanor It -)2Z NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Eleanor King Female Date of Death Age 'If Veteran of U.S. Armed Forces, 08/31/2018 96 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Johnsburg Town Street Address Adirondack Tri-County Nursing And Rehabilitation Center, Inc. Manner of Death©Natural Cause El Accident 0 Homicide Ej Suicide El Undetermined El Pending Circumstances Investigation Medical Certifier Name Title James Hindson MD Address 112 Ski Bowl Rd,Johnsburg Town, New York 12853 Death Certificate Filed District Number Register Number City, Town or Village North Creek 5655 21 ❑Burial Date Cemetery or Crematory 09/04/2018 Pine View Crematory ❑Entombment Address ®Cremation Queensbury Town, New York Date Place Removed ❑Removal and/or Held and/or Address Hold Date Point of 0 Transportation Shipment by Common Destination - Carrier Disinterment Date Cemetery Address ID Reinterment Date Cemetery Address '' 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 Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/04/2018 Registrar of Vital Statistics Kathleen C.Lorah(Electronically Signed) (signature) District Number 5655 Place North Creek, New York P. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition q/c j]g Place of Disposition utl .. :*a1prh— 0 (address) (section) /(I t number) ( (grave number) Name of Sexton or Person in Charge of Premises ( �r�A 1'tr J - it ///_ (please Print) Signature f s� 4; Title (R 1 (over) DOH-1555 (02/2004)