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Miller, William W Jr. - NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex William W.Miller Jr. Male Date of Death Age If Veteran of U.S.Armed Forces, 11/22/2023 73 Years War or Dates Place of Death Hospital,Institution or ECity,Town or Village Chester Town Warren Street Address 460 Rock Avenue,Chester Town Warren,New York 12817 `p Manner of Death IZ Natural Cause Accident El HomicideSuicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title O Hilary Jones NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Chester District Number Register Number City,Town or Village 5652 22 Burial Date Cemetery,Crematory or Facility Name 11/27/2023 Pine View Crematory Entombment — Address ©Cremation Queensbury Town,New York Donation Z Date Place Removed 0❑Removal and/or and/or Held t- Hold Address N 0 n Date Point of (!)OTransportation 13 by Common Shipment Carrier Destination Disinterment Date Cemetery Address EReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom 1- Remains are Shipped,If Other than Above 5 Address cc UJ O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/24/2023 Registrar of Vital Statistics Mindy Conway(ECectronica1Cy Signed) (signature) District Number 5652 Place Town Of Chester I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H W C Date of Disposition f f'z7-202 Place of Disposition /nth e U r&v) ZfQ r►' �r G (address) l!J CC (section) (lot number) number) (grave number) O Name of Sexton or Pers Cha of Premises tv i i1 Cd w�+ c he (please print) f W Signature Title L re rr er y ),c,x,/,e r DOH-1555(07/18)p t 2