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Plumley, Lew A
4 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Lew A.Plumley Male Date of Death Age If Veteran of U.S.Armed Forces, 12/29/2023 88 Years War or Dates 1954-1956 i_ Place of Death Hospital,Institution or Z City,Town or Village Long Lake Town Street Address 45 Kickerville Lane, Long Lake Town, New York 12847 W p Manner of Death Z Natural Cause Accident ❑Homicide ESuicide Undetermined Pending V Circumstances Investigation W Medical Certifier Name Title CI Melanie Duerr NP Address 47 Tom Phelps Lane,Mineville Hamlet,New York 12996 Death Certificate Filed Town Of Long Lake District Number Register Number City,Town or Village 2056 12 Burial Date Cemetery,Crematory or Facility Name 12/29/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0[:]Removal Date Place Removed and/or and/or Held F- Hold Address N 0 CL Date Point of 0)oTransportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address El 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 i— Remains are Shipped,If Other than Above 2 Address CC W EL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/29/2023 Registrar of Vital Statistics Dixie ue 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— � Z Date of Disposition /Z.�'v�3 Place of Disposition ! f n'e aepe/� '44,Ivl`/f w (address) 2 W Cl)CC (section) (lot number/ (grave number) ofa9�a� uJ 0 Name of Sexton or Person in Charge of remis Calms Z .�_�� r (please pn t) W Signature 44' Title �f 't��. DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) 01 Receipt Human remains of delivered on , 20 t' Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#