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Helms, Maureen A 6r► �l z y NEW YORK STATE DEPARTMENT OF HEALTH _ Bureau of Vital Records _ Burial Transit Permit Name First Middle Last Sex Maureen A. Helms Female Date of Death Age If Veteran of U.S.Armed Forces, 08/03/2023 72 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Vestal Town Street Address 605 Clayton Avenue,Vestal Town, New York 13850 CIManner of Death ❑Natural Cause []Accident Homicide []Suicide Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title CI Diane Deferrante MD Address 4102 Vestal Road,Vestal, New York 13850 Death Certificate Filed Town Of Vestal District Number Register Number City,Town or Village 0364 129 Burial Date Cemetery,Crematory or Facility Name 08/05/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town, New York Donation 0❑Removal Date Place Removed and/or and/or Held H Hold Address 0 d Date Point of U) Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address 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 5 Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/04/2023 Registrar of Vital Statistics Debra Wallace(Electronically Signed) (signature) District Number 0364 Place Town Of Vestal I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I- W Date of Disposition $-j23 Place of Disposition ��� j/,ie,4f 2 (address W N (section) (lot umber) (grave number) Name of Sexton or Person in Charge of Premises �?VrlldAt�j GO (please print) Z / W Signature 930 < Title trr ,- DOH-1555(07/18)p id 2 9 Public Health Law Sec. 4145(2b) I Receipt Human remains of f' delivered on , 20, Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#