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Mulford, Mildred Ione +< ,_ NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Mildred lone Mulford Female Date of Death Age If Veteran of U.S.Armed Forces, 08/29/2021 90 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc `p Manner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending VCircumstances Investigation W Medical Certifier Name Title Diane Westbrook NP Address 131 Lawrence St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 487 ❑Burial Date Cemetery,Crematory or Facility Name 09/01/2021 Plne View Crematorium 0 Entombment • Address ▪Cremation Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held - Hold Address 0 a Date Point of Cl) ❑Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 2 Address LC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/31/2021 Registrar of Vital Statistics John Paul cFranck(ECectronicallySigned) (signature) District Number 4501 Place Saratoga Springs, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z▪ Date of Disposition 'I Z l 7s Place of Disposition (ad ess) W LC N (section) (lot number) (grave number) 8 Name of Sexton or Person in Charge of Premises 0s* (p se print/ .�- W Signature '� Title < A stir DOH-1555(07/18)p 1 of 2 I 015102 Public Health Law Sec. 4145(2b) Receipt Human remains of i ' - delivered on , 20 Pine View Cemetery Representing the funeral home named gn,b)urial permit Official Funeral Directors Reg.or License#