Venton, Mildred NEW YORK STATE DEPARTMENT OF HEALTH . t 0 Tol
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Mildred G. Venton Female
Date of Death Age If Veteran of U.S. Armed Forces,
April 6,2015 87 War or Dates
1, Place of Death Hospital, Institutior1irondack Tri-County Health Care
Z' City, Town or Village T/O Johnsburg Street Address Center
o' Manner of Death Undetermined Pending
X Natural Cause Accident Homicide Suicide
ILL Circumstances Investigation
u: Medical Certifier Name Title
4:11, Paul Bachman MD
Address
H HIN,Warrensburg,NY 12885
`a Death Certificate Filed District Number Register Number
City, Town or Village T/O Johnsburg 5655 P
❑Burial Date Cemetery or Crematory
April 8,2015 Pine View Crematory
ri Entombment Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
ca
O Date Point of
O.
Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
I Ij Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
.'_, Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
t- Remains are Shipped, If Other than Above
• Address
ft
ill'
• Permission is hereby granted to dispose of the human r 'n s described ove as . dicated.
e cit ,
Date Issued j Registrar of Vital Statistick_ ,
(signature
District Number 5655 Place T/O Johnsburg,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition L fto j;lc Place of Disposition —, er,.44=,J,,,
2 (address)
W
N
W (section) (tot number) (grave number)
Q Name of Sexton or Person in Charge of Premises 144.0i .3,,,;,11
'Z (phase print)
Signature Title t t .-
(over)
DOH-1555 (02/2004)