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Miles John Town of Queensbury Certification of Cremation Pine View Cemetery and Crematory This certifies that the remains of: John Miles were cremated on August , 5 20 21 at the Pine View (Month) (Day) Crematorium, Queensbury,New York, and these are the cremated remains of said body. Date of Death August , 1 20 21 Age 68 (Month) (Day) Funeral Home Carleton Funeral Home Registered No. 638 (Authorized Signature) .. • I A 63? NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John Alan Miles Male Date of Death Age If Veteran of U.S.Armed Forces, 08/01/2021 68 Years War or Dates . , Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital LU p Manner of Death © Natural Cause El Accident 0 Homicide 0 Suicide 0 Undetermined Ei Pending W Circumstances Investigation U Title LU Medical Certifier Name CI Shahid Ahmed MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 323 ❑Burial Date Cemetery,Crematory or Facility Name 08/04/2021 Pine View Crematorium ElEntombment Address DCremation Queensbury Town,New York Donation g El Date Place Removed Removal and/or Held F- and/or N Hold Address 0 Date Point of Cl) Li Transportation Shipment p by Common Carrier Destination Date Cemetery Address Disinterment Date Cemetery Address ElReinterment Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67, Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom u Remains are Shipped,If Other than Above g Address CC LU a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/03/2021 Registrar of Vital Statistics cR96ertAndrew Curtis(ECectronicalrySigned) (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 ,f Z Date of Disposition i 16 11,( Place of Disposition �f'MUt.._ r'_ W (address) W NCC (section) 4 (lot number) (` (grave number) 0 Name of Sexton or Person in Charge of Prem' es in `/ /ple s e print/ Z 1 0I IlJ Signature Title DOH-1555(07/18)p 1 of 2 a' ,-)')i-, .1„. ,J ..,,C.. 1 Public Health Law Sec. 4145(2b) Receipt _..- 1 Human remains of / • -). delivered on , 20 - • , - • ( ,/ -' 1 Pine View Cemetery Representing the funeral home named on burial permit I Official Funeral Directors Reg.or License#