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Miner, Michael L g(42 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Michael L.Miner Male Date of Death Age If Veteran of U.S.Armed Forces, 10/17/2023 67 Years War or Dates E., Place of Death Hospital,Institution or Z City,Town or Village Moreau Town Street Address 82 Lamplighter Acres, Moreau Town,New York 10950 p Manner of Death ❑� Natural Cause Accident ❑Homicide OSuicide Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title CI Robert Ball Coroner Address 6010 County Farm Road,Ballston Spa Village,New York 12020 Death Certificate Filed Town Of Moreau District Number Register Number City,Town or Village 4562 58 Burial Date Cemetery,Crematory or Facility Name 10/19/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Z❑Removal Date Place Removed and/or and/or Held N Hold Address 0 O. Date Point of Cl) Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address OReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom ▪ Remains are Shipped,If Other than Above a Address W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/19/2023 Registrar of Vital Statistics Brenda"futter(1Yctrotrica/T SWnerl) (signature) District Number 4562 Place Town Of Moreau I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: l— Z Date of Disposition Jo I Zo i Z3 Place of Disposition �'I ✓ 4bJ 6@f,/ ArgeLus� W 2 (address) W N Q (section) (lot number) (grave number) GName of Sexton or Person in Charge of Prem. ,) �l11 Z tease print) ` W Signature Title /lT� DOH-1555(07/18)p 1 of 2 7391 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#