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Goodwill, Hilda E - --)---) NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Aii N\ Name First Middle Last Sex Hilda E.Goodwill Female Date of Death Age If Veteran of U.S.Armed Forces, 04/26/2021 100 Years War or Dates F Place of Death Hospital,Institution or Z City,Town or Village Johnsburg Town Street Address Elderwood at North Creek W Manner of Death Undetermined Pending � © Natural Cause �Accident �Homicide �Suicide W C.) Circumstances Investigation W Medical Certifier Name Title CI Michael Miles MD Address 112 Ski Bowl Rd,Johnsburg Town,New York 12853 Death Certificate Filed District Number Register Number City,Town or Village North Creek 5655 14 ❑Burial Date Cemetery,Crematory or Facility Name 04/26/2021 Pine View Crematory ElEntombment Address ElCremation Queensbury Town,New York Donation ZO Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 O. Date Point of U) ❑Transportation Shipment p by Common 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 I— Remains are Shipped,If Other than Above g Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/26/2021 Registrar of Vital Statistics Kathleen C. Lorah(Electronically Signed) (signature) District Number 5655 Place North Creek, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I6— Z Date of Disposition 9 I Zi I Z.( Place of Disposition ddress11.— G..�— W ( ) 2 W N (section) lot number) (grave number) CC G Name of Sexton or Person in Charge of Premises b ,"' (please p.tt int) /� �_ W Signature Title ` DOH-1555(07/18)p 1 of 2 . ti4 Public Health Law Sec. 4145(2b) ` i 4 , o:: Receipt Human remains of a '. delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# 1