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Millington, William NEW YORK STATE DEPARTMENT OF HEALTH �3.7 Vital Records Section Burial - Transit Permit Name First Middle Last Sex ` William W. Millington Male : Date of Death Age If Veteran of U.S. Armed Forces, November 24,2014 90 War or Dates World War II `" Place of Death Hospital, Institution or City, Town or Village Bolton Street Address 4376 Lake Shore Drive ta Manner of Death ❑NNatural Cause Accident ❑Homicide Suicide Undetermined n Pending Circumstances Investigation u Medical Certifier Name Title IP Paul Bachman Dr. Address :te• a HHHN,Warrensburg,NY 12885 Death Certificate Filed District Number Register Number /; City, Town or Village T/O Bolton 5650 y ❑Burial Date Cemetery or Crematory November 26,2014 Pine View Crematory ❑Entombment Address ©Cremation 21 Quaker Rd., Queensbury,NY 12804 Date Place Removed Z Removal and/or Held and/or Address H Hold N 0 Date Point of wTransportation Shipment p by Common Destination Carrier El Disinterment Date Cemetery Address n Reinterment Date Cemetery Address ;1: Permit Issued to Registration Number ga G Name of Funeral Home Alexander-Baker Funeral Home 00037 '-'4 Address '` 3809 Main Street,Warrensburg,NY 12885 Name of Funeral Firm Making Disposition or to Whom 14, Remains are Shipped, If Other than Above Address 1 • Permission is hereby granted to dispose of the human rem in described love as indi ated. ; 6 Date Issued f/-vl4P-, .-9//Registrar of Vital Statistics • District Number 5650 Place T/O Bolton 'm. I certify that the remains of the decedent identified above were disposed of inn accordance with this permit on: w° Date of Disposition 121 LINN Place of Disposition �w ,,. C,.- "•.. 2 (address) W CO 1Y (section) j -(lot number) (grave number) pName of Sexton or Person in Charge of Premises // t& Z lease print) w Signature /4- 4_,, Title COaF-1+tiiin (over) DOH-1555 (02/2004)