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Miller Margaret Ann 4111) NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Margaret Ann Miller Female Date of Death Age If Veteran of U.S.Armed Forces,. 7(r 08/20/2022 80 Years War or Dates ,,, E— Place of Death Hospital,Institution or Z City,Town or Village Malta Town Street Address 26 Rock Rose Way,Malta Town,New York 12020 UJ p Manner of Death n n Natural Cause Accident n Homicide Suicide Undetermined Pending W I (Circumstances Investigation U W Medical Certifier Name Title CI Madison Zuis NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Malta District Number Register Number City,Town or Village 4560 46 RBurial Date Cemetery,Crematory or Facility Name 08/23/2022 Pine View Crematory Entombment Address Cremation Queensbury Town,New York Donation Z Removal Date Place Removed and/or and/or Held H Hold Address U) 0 O. Date Point of U)[]Transportation p by Common Shipment Carrier Destination o Disinterment Date Cemetery Address El 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 1— Remains are Shipped,If Other than Above Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/23/2022 Registrar of Vital Statistics Jennifer 9KarieJfo(mes(EfectronicallySigned) (signature) District Number 4560 Place Town Of Malta I certify that the remains of the decedent identified above were disposed of in accordance with this permit oh: Z Date of Disposition g,7lr 1t.,Ze. Place of Disposition de (lie ) Ct ,4, 1 UJ 2 (address) W NCC (section) (lot nu ben) i (grave number) gName of Sexton or Person in Charge of Premis �� I rn Ups (/ C' Z (please print) W Signature <7061 Title ©fterec °r DOH-t555(o7/18)pi of 2 „ I ;. Public Health Law Sec. 4145(2b) �R Receipt z Human remains of ° +, ` ( delivered on , 20 Jf',. / Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# I. ? 1%2(I