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Miller, Douglas Rollo 101. Og NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Douglas Rollo Miller Male Date of Death Age If Veteran of U.S.Armed Forces, 11/23/2023 83 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital p• Manner of Death El Natural Cause Accident Homicide Ei Suicide Undetermined ❑Pending ✓ Circumstances Investigation 0 Medical Certifier Name Title Mark Weidner MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed City Of Saratoga Springs District Number Register Number City,Town or Village 4501 667 Burial Date Cemetery,Crematory or Facility Name 11/27/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York DDonation OZ❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 O. Date Point of fn❑Transportation p by Common Shipment Carrier Destination Date Cemetery Address ❑Disinterment Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 2 Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/27/2023 Registrar of Vital Statistics Dia-on Moran(El ctronica1TySigned) (signature) District Number 4501 Place City Of Saratoga Springs I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I- Z Date of Disposition 11130 I Z3 Place of Disposition '�'�NEo; (p Mt4Td�1j// 2 (address) W N (section) A (lot number) (grave number) iZ O Name of Sexton or Person in Charge of Pre ises n�'4 �.,, N^�t ft / ease print) W Signature Title � ���� DOH-1555(07/18)p 1 of 2 0 nt 7 S 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#'