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Spengler, Lorraine # il 0 , ..1 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Lorraine Spengler Female Date of Death Age If Veteran of U.S.Armed Forces, 11/20/2023 90 Years War or Dates f '' f.. Place of Death Hospital,Institution or WCity,Town or Village Long Lake Town Street Address 367 Kickerville Lane, Long Lake Town, New York 12847 p• Manner of Death ❑Natural Cause IllAccident ❑Homicide Suicide Undetermined ❑Pending U Circumstances Investigation aW Medical Certifier Name Title Carl Turner Coroner l`, Address 1188 Main Street,Long Lake Hamlet, New York 12847 Death Certificate Filed Town Of Long Lake District Number egister Number City,Town or Village 2056 9 Burial Date Cemetery,Crematory or Facility Name 11M' 12/05/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York • Donation 6❑Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 O. Date Point of Cl)ElTransportation p by Common Shipment Carrier Destination EiDisinterment 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 F.. Remains are Shipped,If Other than Above N Address Ct W a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/04/2023 Registrar of Vital Statistics Dixie Lee Leblanc(Electronically Signed) (signature) District Number 2056 Place Town Of Long Lake I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— W Date of Disposition 12 I 17, Place of Disposition �7dG/i L. t.) Fj►y4i7 M (address) W Cl) (section) t/e�(lot number (grave number) O Name of Sexton or Person in Charge o Premises L nl�{ Z > (prise print/ /� Ili Signature / <7` Title _ l 1?tG nMF11 DOH-1555(07/18)p 1 of 2 .±1 ( P P,,. Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Offici• Funeral Directors Reg.or License#