Millington Sr, Gary yip
NEW YORK STATE DEPARTMENT OF HEALTH / '
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
w = Gary H. Millington, Sr. Male
1 Date of Death Age If Veteran of U.S. Armed Forces,
M - July 4,2014 74 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death C Natural Cause Accident E Homicide Suicide n Undetermined Pending
10 Circumstances Investigation
tifk Medical Certifier Name Title
Dr.William Borgos
Address
14 Manor Drive,Queensbury,NY 12804
Death Certificate Filed District Number ,'Reg i r'Number
R City, Town or Village Glens Falls 5601
ā¯‘Burial Date Cemetery or Crematory
El Entombment July 7,2014 Pine View Crematory
Address
El Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z
IEl I Removal and/or Held
and/or Address
Hold
0 Date Point of
w I l Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
k= Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
1
10
Permission is he eby granted to dispose of the human re Heins des ribed abo e as indicate .
Date Issued L Registrar of Vital Statistics ei_ , ie YO2
-.J (signature)
p . District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ui Date of Disposition '")-(0-(t Place of Disposition ett,).j ( 6`,r
Ill (address)
U)
r (section) (lot numbe (grave number)
p, Name of Sexton or Person ' Charge of Premises L p;,} .,a,N+tdg
Z (please pant)
W
Signature 71, Title r Pri
(over)
DOH-1555(02/2004)