Miller.Paul Stephen (-L1F)NEW YORKSTATE DEPARTMENTOF HEALTHBurial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Paul Stephen Miller Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/06/2022 63 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death ❑X Natural Cause El Accident El Homicide ❑Suicide ❑Undetermined ❑Pending
W C.) Circumstances Investigation
W Medical Certifier Name Title
O Sean Bain MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 92
❑Burial Date Cemetery,Crematory or Facility Name
02/10/2022 Pine View Crematory
Entombment Address
®Cremation Queensbury Town,New York
ElDonation
Removal Date Place Removed
and/or and/or Held
- Hold Address '
0
O. Date Point of
N ❑Transportation Shipment
p by Common
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
ElReinterment
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
2 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/10/2022 Registrar of Vital Statistics MeganNolin(Electronicall;Signe4
(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:
IF-
Z Date of Disposition Place of Disposition pine, erw (Asti 1(Tkry
(address)
W
CC N (section) (lot number) (grave number)
S
• Name of Sexton or Person in Charge of Premises cJ L�>� >
(please print)
W Signature Title (--e c.K'
DOH-1555(07/ )p l of 2
0 1 5634
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home gamed on burial permit
Official Funeral Directors Reg.or License#