Loading...
Friedman, Martin D f — gig NEW YORKSTATE DEPARTMENT OF HEALTH ' �' iiii Burial - Transit Permit Bureau of Vital Records "" Name First Middle Last Sex Martin D. Friedman Male Date of Death Age If Veteran of U.S.Armed Forces, 10/09/2023 82 Years War or Dates 1_, Place of Death Hospital,Institution or Z City,Town or Village Harrietstown Town Street Address Adirondack Medical Center-Saranac Lake Site LU Manner of Death I:INatural Cause Accident ❑Homicide Suicide Undetermined Pending U Circumstances Investigation W Medical Certifier Name Title O Justine Lawrence PA Address 2233 State Rte 86 PO Box 471,Harrietstown Town,New York 12983 Death Certificate Filed Town Of Harrietstown District Number Register Number City,Town or Village 1663 68 Burial Date Cemetery,Crematory or Facility Name 10/11/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town, New York ▪Donation 0❑Removal Date Place Removed and/or and/or Held H Hold Address U) 0 n- Date Point of U)ETransportation 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 H Remains are Shipped,If Other than Above 2 Address CC W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/11/2023 Registrar of Vital Statistics Sabrina Harrison(Electronically Signed) (signature) District Number 1663 Place Town Of Harrietstown I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— W 'f Te Date of Disposition 10 Ill I 73 Place of Disposition .Ev.J16c./ (PiAll•rozDtki 2 (address) W U) CC (section) /] (lot number) (grave number) 0Name of Sexton or Person in Charge f Premises ///t 1'1 �" +t If Z � (ease print) W Signature Z:1 Title IMAire._ DOH-1555(07/18)p 1 of 2 T 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#