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Miner Jr., Earl Clifford 0°3( NEW YORK STATE DEPARTMENT OF HEALTH Burial- Transit Permit Bureau of Vital Records Name First Middle Last Sex Earl Clifford Miner Jr Male Date of Death Age If Veteran of U.S.Armed Forces, 01/07/2021 70 Years War or Dates 1970-1973 Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death ©Natural Cause ❑Accident 1=1 Homicide El Suicide El Undetermined El Pending W Circumstances Investigation Q Medical Ceryfier Name Title Sean Bain MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 9 ElBurial Date Cemetery,Crematory or Facility Name 01/08/2021 Pine View Crematory ElEntombment Address 0 Cremation Queensbury Town,Warren,New York IDDonation ZO �Removal Date Place Removed and/or and/or Held - Hold Address O n. Date Point of j Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Edward L Kelly Funeral Home 00519 Address PO Box 548,Schroon Lake,New York 12870 Name of Funeral Firm Making Disposition or to Whom l- Remains are Shipped,If Other than Above M Address W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/08/2021 Registrar of Vital Statistics 4Np6ertAndrew Curtis(E(ectronicaffy Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I^ Z Date of Disposition J— 4,oz/ Place of Disposition }it•„&e W ( sl W C / (section) (lotnu rl (grave number) 0 Name of Sexton or Person in Cha f Premis s (please print) W Signature Title 1 DOH-1555(07/18)p i of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#