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Miller, Barbara Mae NEW YORK STATE DEPARTMENT OF HEALTH @ Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Barbara Mae Miller Female Date of Death Age If Veteran of U.S.Armed Forces, 04/07/2021 83 Years War or Dates i_ Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital p▪ Manner of Death © Natural Cause 0 Accident El Homicide El Suicide El Undetermined 0 Pending ui Circumstances Investigation W Medical Certifier Name Title 0 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 170 ©Burial Date Cemetery,Crematory or Facility Name 04/12/2021 Pine View Cemetery ❑Entombment Address Cremation Queensbury,New York ElDonation Z ElRemoval Date Place Removed and/or and/or Held Hold Address 10 2 Date Point of (n ❑Transportation Shipment a by Common Carrier Destination Date Cemetery Address ElDisinterment Date Cemetery Address Reinterment Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above a Address CC W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/08/2021 Registrar of Vital Statistics qZp6ertAndrew Curtis(ECectronicalfy 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 4/12/2021PlaceofDisposition 21 QuakPr Rd.. Queensbury,NY 12804 ILI ss) W Mohican C 2 Cr (section) (lot number) (grave number) 8 Name of Sexton o erson in Charge of Premises Connie Goedert (please print) Z Superintendent IU Signature /7446 e Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 012850 Receipt 1 , 1 Human remains of L ' delivered on ' —, , 20 1 , ,, I .,-. Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# 1,. _ MILLER LF NAME Barbara Mae Miller Age_ 83 Lot Owner: Therian & Barbara Miller Lot# Mohican Lot 72 Sec. C Grave# 2 Case: Concrete Died: 4/7/2 0 21 Interred:4/1 2/2 0 21 Funeral Home: Regan Denny Stafford Cemetery: Pine View