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Miller, Kenneth NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kenneth Miller Male Date of Death Age If Veteran of U.S.Armed Forces, 10/07/2023 81 Years War or Dates 1959-1965 �.. Place of Death Hospital,Institution or Z City,Town or Village Horicon Town Street Address 31 Maine Boulevard,Horicon Town,New York 12815 Manner of Death El Natural Cause Accident El Homicide Suicide EilUndetermined ElPending UCircumstances Investigation WQ Medical Certifier Name Title Lynn Keil PA Address 1340 State Route 9,Lake George Town,New York 12845 Death Certificate Filed Town Of Horicon District Number Register Number City,Town or Village 5654 6 Burial Date Cemetery,Crematory or Facility Name 10/10/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation ❑Removal Date Place Removed - and/or and/or Held i- Hold Address O LL Date Point of (I)ElTransportation p by Common Shipment Carrier Destination Date Cemetery Address ❑Disinterment nReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/08/2023 Registrar of Vital Statistics y( aG Wool(E(ectronicallySigned) (signature) District Number 5654 Place Town Of Horicon I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H W Date of Disposition %Q/F ZoZ 3 Place of Disposition �(� ea) -kr( 2 (address) W U) (section) (lot number) (grave number) SName of Sexton or Person in Ch e of remits Y/yl(?,,) az, (p/ease print) W Signature A Title of t0� DOH-1555(07/18)p 1 of 2 T i Public Health Law Sec. 4145(2b) 1 Receipt /fir ' .,r Human remains of r ' ' r 'a,� delivered on A t:` ' , 20,-:i Pine View Cemetery Representing the'funeral home named on burial psrmit Official Funeral Directors Reg.or License# '_- -= `"r