Miner, David LF
Town of Queensbury
14 Certification of Cremation
� 0 Pine View Cemetery and Crematory
This certifies that the remains of: David Miner
were cremated on December 23 20 20 at the Pine View
(Month) (Day)
Crematorium, Queensbury,New York, and these are the cremated remains of said body.
Date of Death December , 16 20 20 Age 69
(Month) (Day)
Funeral ome Regan Denny Stafford Registered No. 1339
Authorized Signature)
. 1/)) 9
II!PP re.,
t 5, die Commonwealth of Massachusetts �i►
tExecutive Office of 1c'u6Cic Safety anifSecurity 1
=t.., z Office of the Chief MerfwalExaminer `,;•: a,
Cremation Authorization Certification
OCME#:
The Laws of the Commonwealth of Massachusetts require a Medical Examiner or Forensic
Investigator certificate. With this signed authorization, the duly appointed and qualified
Medical Examiner/Forensic Investigator of the Commonwealth of Massachusetts certifies that
the body of the decedent listed was viewed, and a personal inquiry into the cause and manner
of death was made. No further investigation or judicial inquiry concerning the cause and
manner is necessary.
Pursuant to the ongoing COVID-19 pandemic and State of Emergency, and in compliance
with the March 23, 2020 Public Health Order issued by the Commissioner of the
Massachusetts Department of Public Health, this decedent may not have been physically
viewed by the undersigned prior to cremation authorization.
Decedent Name: MINER. DAVID R
Date of Death: 12/16/2020
Time of Death: 4:33AM
Location of Death: Boston
Medical Examiner/Forensic Investigator: Christine Curtis
Comments:
12/21/2020
Medical Examiner/Forensic Investigator Signature Date of Certification
CzM4h /A- aezo
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ID-870031
Public Health Law Sec. 4145(!b)„ : 14 3 2 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#
{
MINER
NAME David Miner Age: 69
Lot Owner: Ginette Miner
Lot# New Kenesaw 43 B Grave# 1
Case: Urn
Died: 1 2/2 3/2 0 2 0 Interred:5/1 4/2 0 21
Funeral Home: Regan Denny Stafford
Cemetery: Pine View
MINER
Owner
Ginette Miner
Address Plot
590 Luzerne Rd Oueenshnry, NY 12804 New Kenesaw
Phone # Lot #
518-542-5761 43 B
Deed # Date
4246 3/16/2021
Cost Foundation Y - N
$650.00
Location East-Woods
West-Purdy
North-Tabor
South-Maynard
Remarks
I KNOWLEDGE THE RECEIPT OF THE RULES AND REGULATIONS OF THE
PINE VIEW CEMETERY:
SIGNATURE: 444r-G'�� %�`� .t J DATE: � / a D - /
SIGNATURE: DATE:
Record of Interments
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