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Whitman, Cindy J
11 137 NEWYORKSTATEDEPARTMENTOFHEALTH • \ LF Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Cindy J.Whitman Female Date of Death Age If Veteran of U.S.Armed Forces, 03/02/2024 55 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Speculator Village Street Address 112 brooks Avenue, Speculator Village, New York 12164 WtU Manner of Death Undetermined Pending Natural Cause Accident Homicide Suicide V Circumstances Investigation W Medical Certifier Name Title CI Timothy Smith CDroner Address PO Box 667,Lake Pleasant, New York 12108 Death Certificate Filed Village Of Speculator District Number Register Number City,Town or Village 2020 1 BurialF. Date Cemetery,Crematory or Facility Name 03/05/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Ei Donation Z❑Removal0 Date Place Removed and/or and/or Held H Hold Address N 0 C- Date Point of (/)ETransportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address El Reinterment 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 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/05/2024 Registrar of Vital Statistics Crystal O'brien(Electronically Signed) (signature) District Number 2020 Place Village Of Speculator I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I—. Z Date of Disposition 3h Zy Place of Disposition F3w45vyf.0 `,Pt^FMAZ2=O-- LLI 2 (address) W CCCC (section) (lot number) (grave number) ft 0 Name of Sexton or Person in Charge of Pr ises Z / �• ` C A pease print) IJJ Signature Title DOH-1555(07/18)p 1 of 2 I :'-'1'1 ;;;)0 '::1 cZ Public Health Law Sec. 4145(2b) t 1 Receipt 1 1 Human remains of delivered on , 20 1 1 9 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#