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Gerber, Jeanne L
r . 5-7s NEW YORKSTATE DEPARTMENT OF HEALTH if Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Jeanne L.Gerber Female Date of Death Age If Veteran of U.S.Armed Forces, 07/14/2023 87 Years War or Dates i... Place of Death Hospital,Institution or Z City,Town or Village Indian Lake Town Street Address 5 Deer Path Trail, Indian Lake Town, New York 12842 W Manner of Death n nUndetermined Pending El Natural Cause Accident I I Homicide Suicide W C.) Circumstances Investigation W Medical Certifier Name Title O Melanie Duerr NP Address 47 Tom Phelps Lane,Mineville Hamlet, New York 12996 Death Certificate Filed Town Of Indian Lake District Number Register Number City,Town or Village 2053 7 Burial Date Cemetery,Crematory or Facility Name 07/17/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 o. Date Point of Cl)❑Transportation Q by Common Shipment Carrier Destination Date Cemetery Address Disinterment El 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 H 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 07/17/2023 Registrar of Vital Statistics Julie A Clawson(Electronically Signed) (signature) District Number 2053 Place Town Of Indian Lake I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition 71111 73 Place of Disposition 17,AILii W (address) W NIX (section) {J (lot numb (grave number) GName of Sexton or Person in Charge of Premises I —Z (Y ease print) ,� �� W Signature Title ( '-�"{ DOH-1555(07/18)p 1 of 2 ao ff r 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#