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Miller, Corey Teves NEW YORK STATE DEPARTMENT OF HEALTH ` Apo— Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Corey Teves Miller Male Date of Death Age If Veteran of U.S.Armed Forces, 09/10/2021 66 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Hudson Falls Village Street Address 235 Main Street B, Hudson Falls Village, New York 12839. W Manner of Death Q © Natural Cause 0 Accident El Homicide 0 Suicide 0 Undetermined El Pending W C.) Circumstances Investigation W Medical Certifier Name Title 0 Wesley Perry „ Coroner Address 415 Lower Main Street, Hudson Falls Village,New York 12839 • Death Certificate Filed District Number Register Number City,Town or Village Hudson Falls Village 5726 26 ElBurial Date Cemetery,Crematory or Facility Name 09/21/2021 Pine View Crematory ❑Entombment Address • 0 Cremation Queensbury Town,New York Donation Z Removal Date Place Removed and/or and/or Held F— Hold Address CO 0 a Date Point of N Li Transportation Shipment Q by Common Carrier Destination Date Cemetery Address ElDisinterment Date Cemetery Address ElReinterment Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above 2 Address W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/20/2021 Registrar of Vital Statistics Cynthia cBardin(ECectronicat(y Signed) (signature) District Number 5726 Place Hudson Falls Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IH I W Date of Disposition 9I2 y l 2i) Place of Disposition l /dress/ `' W It (section) (lot number) (grave number/ Q• Name of Sexton or Person in Charge of Premises M '). Z (p ase print) / W Signature Lam' Title /r�rl'� �1 K DOH-1555{07/18)p 1 of 2 01 5172 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#