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Hutchins, Meade C. 47c NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Meade C Hutchins Male Date of Death Age If Veteran of U.S.Armed Forces, 01/06/2021 67 Years War or Dates I_ Place of Death Hospital,Institution or 2 City,Town or Village Indian Lake Town Street Address 1070 Big Brook Road, Indian Lake Town, New York 12842 W p Manner of Death ©Natural Cause Accident 0 Homicide Suicide ❑Undetermined ❑Pending W C.) Circumstances Investigation W Medical Certifier Name Title CI Charles Yun MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Indian Lake 2053 1 ❑Burial Date Cemetery,Crematory or Facility Name 01/07/2021 Pine View Crematory EI Entombment Address O Cremation Queensbury Town, New York ❑Donation ZO Removal Date Place Removed and/or and/or Held - Hold Address N 0 a. Date Point of to Li Transportation CI by Common Shipment Carrier Destination 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 Remains are Shipped,If Other than Above M Address EC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/07/2021 Registrar of Vital Statistics Julie A Clawson(Electronically Signed) (signature) District Number 2053 Place Indian Lake, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: L Z Date of Disposition I i$i L' Place of Disposition e UJ (a dress W CC W (section) (lot number) (grave number) GName of Sexton or Person in Charge of Prem. es Z (p/e se print) W Signature Title ( 41 rO`{ DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 3$9 Receipt Human remains of' delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#