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Meehen Jr., James R. .. NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex James R.Meehan Jr. Male Date of Death Age If Veteran of U.S.Armed Forces, 01/01/2021 76 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Tupper Lake Town Street Address Mercy Living Center ILI p Manner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide Undetermined ❑Pending W U Circumstances Investigation W Medical Certifier Name Title CI Mario Tagliagambe MD Address 114 Wawbeek Ave,Tupper Lake Town, New York 12986 Death Certificate Filed District Number Register Number City,Town or Village Tupper Lake 1650 1 ❑Burial Date Cemetery,Crematory or Facility Name 01/04/2021 Pine View Crematory Entombment Address Cremation Queensbury Town,New York ❑Donation Z Removal Date Place Removed and/or and/or Held i Hold Address f) 0 a 1-1 Date Point of U) ❑Transportation Shipment p by Common Carrier Destination El Disinterment Date Cemetery Address ❑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 1. Remains are Shipped,If Other than Above 2 Address uJ a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/04/2021 Registrar of Vital Statistics Laurie J Fuller(Electronically Signed) (signature) District Number 1650 Place Tupper Lake, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ~ 7L, d_ WDate of Disposition l'S�� Place of Disposition 2 address) W NCE (section) d (l number) (grave number) 0 Name of Sexton or Person in Charge of P mises �` c5:,..i Z (pie a print) �^ ,�/� Ilic Signature Title �}'1 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) ; 1_4 3 (3 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#