Austin, Harold M Jr. 011111) /t511
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Harold M.Austin Jr Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/09/2022 94 Years War or Dates 1951-1971
i_ Place of Death Hospital,Institution or
Z City,Town or Village Long Lake Town Street Address 49 Clement Road, Long Lake Town, New York 12847
11.1
p Manner of Death El Natural Cause IllAccident 7 Homicide IllSuicide ❑Undetermined ❑Pending
UCircumstances Investigation
LU Medical Certifier Name Title
Melanie Duerr NP
Address
47 Tom Phelps Lane,Mineville Hamlet,New York 12996
Death Certificate Filed Town Of Long Lake District Number Register Number
City,Town or Village 2056 2
Burial Date Cemetery,Crematory or Facility Name
07/13/2022 Pine View Crematory
Entombment Address
aCremation Queensbury Town, New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
F- Hold Address
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0
a Date Point of
(n Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
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
l— Remains are Shipped,If Other than Above
2 Address
CC
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a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/11/2022 Registrar of Vital Statistics Dixie Lee Leblanc(Electronically Signed)
(signature)
District Number 2056 Place Town Of Long Lake
I certify that tie remains of the decedent identified above were disposed of in accordance with this permit on:
Il— � �J
Z Date of Disposj o 1113I tZ Place of Disposition -1 M1.V►. .
2 (address)
W
CO
CC (section) J (lot numb / (grave number)
0 Name of Sexton or Person in Charg Premises n L vvv41
Z please print)
Ill az 4701Z
Signature Title
DOH-1555(07/18)p 1 of 2
rt
Public Health Law Sec. 4145(2b)
f :
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#