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Miller, Sandra Jean - /I01 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Sandra Jean Miller Female Date of Death Age If Veteran of U.S.Armed Forces, 12/20/2021 79 Years War or Dates i_ Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital LU Manner of Death Pending � ©Natural Cause �Accident �Homicide �Suicide �Undetermined � W Circumstances Investigation U W Medical Certifier Name Title CI Christopher Smith MD Address 100 Park St,Glens Falls, New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 615 ElBurial Date Cemetery,Crematory or Facility Name 12/21/2021 Pine View Crematory Entombment Address 0 Cremation Queensbury Town,New York ❑Donation 6 0 Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 d Date Point of V) Li Transportation Shipment Q by Common Carrier Destination El Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom F— Remains are Shipped,If Other than Above 5 Address CC W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/21/2021 Registrar of Vital Statistics Men Andrew Curtis(Electronically Signed) (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: AIL C _' WDate of Disposition 11173 171 Place of Disposition (i'?< 2 (address) W CCCC (section) "number) (grave number) 0 Name of Sexton or Person in Charge of Premises ' • �— PhnA�t Z ' `►s (please pr t) LL Signature /!'�/ Title a7/041 09g., DOH-1555(07/18)p 1 of 2 L y €`y1 470 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#