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Nelaon, Neal K tr a3b N EW YORK STATE DEPARTMENT OF H EALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Neal K. Nelson Male Date of Death Age If Veteran of U.S.Armed Forces, 03/03/2024 77 Years War or Dates Vietnam H Place of Death Hospital,Institution or Z City,Town or Village Indian Lake Town Street Address 381 Chamberlain Road, Indian Lake Town, New York 12842 W Manner of Death n HomicideIII Suicide Undetermined Pending W Natural Cause Accident I 1 U Circumstances Investigation W Medical Certifier Name Title O Matthew Miller Coroner Address P.O.Box 76,Inlet Town,New York 13360 Death Certificate Filed Town Of Indian Lake District Number Register Number City,Town or Village 2053 1 EiBurial Date Cemetery,Crematory or Facility Name 03/05/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York ▪Donation Q Removal Date Place Removed and/or and/or Held E Hold Address 0 d. Date Point of Cl)IIITransportation Q by Common Shipment Carrier Destination O Disinterment 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 H Remains are Shipped,If Other than Above 2 Address Et W E' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/05/2024 Registrar of Vital Statistics Julie A Clawson(Electronically Signed) (signature) District Number 2053 Place Town Of Indian Lake I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F— Z Date of Disposition 3 h\7 4 Place of Disposition P TOO;611.,) 434 NI4'j()g'Si` W 2 (address) W Cl)CC (section) d (lot number) (grave number) crAkAci Name of Sexton or Person in Charge of P emises ��rp�- iH Z lease print/W Signature c2 /'Title [ k/44-tiAtz._ DOH-1555(07/18)p 1 of 2 4 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#