Miner, Claude NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Claude E. Miner (Male
Date of Death Age If Veteran of U.S. Armed Forces,
War or Dates
WW
Place of Death Hospital, Institution or
City, Town or Village Lake Placid Street Address 24 McLenathen St.
Manner of Death U Natural Cause Accident ❑Homicide ❑Suicide ❑ Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
H V W Ber amini MD.
Address
Swiss Road, Lake Placid
Death Certificate Filed District Number Register Number
City, Town or Village Lake Placid 1523
Date Z, J Cemetery or Crematory
El Burial J U N E Pine View Cremator
Address
Cremation Glens Falls, NY
Date Place Removed
Z ❑Removal and/or Held
and/or Address
Hold
Q Date Point of
❑Transportation Shipment
Q by Common Destination
Carrier
❑Disinterment
Date Cemetery Address
❑Reinterrnent Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Clark, Inc. 00378
Address
27 Saranac Ave. , Lake Placid, NY
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 Issue JJJ2/99 Registrar of Vital Statistics ,
(signature)
District Number 1523 Place
Lake- Placid, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition�o `' Place of Disposition
2 (address)
Uj
N
tx ( eection,). ) Q (lot um (gr ve number)
GName of Sext or Person n Charge of Premises
z (please print) t-7-
W Signature Title , 1
DOH-1555 (10/89) p. 1 of 2 VS-61