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Plumley, Jeanne M. .# y0 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Jeanne M. Plumley Female Date of Death Age If Veteran of U.S.Armed Forces, 05/28/2021 84 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Harrietstown Town Street Address Adirondack Medical Center-Saranac Lake Site W Manner of Death Undetermined ❑Pending � ©Natural Cause �Accident �Homicide �Suicide W U Circumstances Investigation IL Medical Certifier Name Title CI Amy Corliss MD Address 2233 State Rte 86 PO Box 471, Harrietstown Town, New York 12983 Death Certificate Filed District Number Register Number City,Town or Village Saranac Lake 1663 26 Burial Date Cemetery,Crematory or Facility Name 06/01/2021 Pine View Crematory IDEntombment Address X❑Cremation Queensbury Town,New York ❑Donation Date Place Removed Removal and/or Held H and/or N Hold Address 0 Date Point of co ❑Transportation Shipment p by Common Carrier Destination Date Cemetery Address EI Disinterment 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 lr- Remains are Shipped,If Other than Above 5 Address CC ILL O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/01/2021 Registrar of Vital Statistics Kareen Ava Tyler(Electronically Signed) (signature) District Number 1663 Place Saranac Lake, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— /7 z Date of Disposition li/31 7,1 Place of Disposition 4z,4L �✓T er---- MI (address) W U) CC (section) //f (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises /n C`-% 3�1"A rt /p'ease print/ Z W Signature Title riMW rk DOH-1555(07/18)p 1 of 2 . ' Public Health Law Sec. 4145(2b) 014 U Receipt Human remains of delivered on , 20 Pine View Cemetery — Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#