Paige, Steven Allen it lot i
NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Per it
Bureau of Vital Records '',:.
Name First Middle Last Sex
Steven Allen Paige • Male
Date of Death Age If Veteran of U.S.Armed Forces,
08/08/2022 47 Years War or Dates
1— Place of Death Hospital,Institution or
Z City,Town or Village Long Lake Town Street Address 8180 Newcomb Road, Long Lake Town, New York 12847
!U Manner of Death Undetermined Pending
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0 Natural Cause Accident [Homicide Suicide [0 Circumstances Investigation
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W Medical Certifier Name Title
O Carl Turner Coroner
Address
1188 Main Street, Long Lake Hamlet,New York 12847
Death Certificate Filed Town Of Long Lake District Number Register Number
City,Town or Village 2056 5
Burial Date Cemetery,Crematory or Facility Name
08/10/2022 Pine View Crematory
Entombment Address
▪Cremation Queensbury Town,New York
▪Donation
ZO❑Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
0
4. Date Point of
(I)[Transportation
CI Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
n Date Cemetery Address
l l Reinterment
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
1— Remains are Shipped,If Other than Above
2 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/10/2022 Registrar of Vital Statistics Dixie Lee Leblanc(Electronically Signed)
(signature)
District Number 2056 Place Town Of Long Lake
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
Z Date of Disposition 0 %7,'iper__ Place of Disposition 04e ill. e..v r7,,,q;-i-e,r—t
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2 (addre
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Q (section) (lot num r) (grave number)
aName of Sexton or Person in Char f Premise ��i�1rl.J7
Z (please print)
W Signature tf tf/ Title yerearso
DOH-1555(07/18)p 1 of 2
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#