Millington, Alvin O Jr. # 2(12
NEW YORK STATE DEPARTMENT OF HEALTH Burial of Vital Records - Transit Permit
Name First Middle Last Sex
Alvin O.Millington Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/15/2022 62 Years W ar o r Dates
F-, Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
ElManner of Death ID Natural Cause ❑Accident 0 Homicide Suicide Undetermined Pending
W
V Circumstances Investigation
UJ Medical Certifier Name Title
Asks Chaudry MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
Cit ,Town or Village 5601 164
Burial Date Cemetery,Crematory or Facility Name
03/18/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Don ation
0❑Removal Date Place Removed
p and/or and/or Held
to Hold Address
2 O
Date Point of
to❑Transportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
�Reinterment
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped,If Otherthan Above
5 Address
Q
uJ
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/16/2022 Registrar of Vita[Statistics . tggan.Kd!sn('E4ctrtmrcaIF'Signsd)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on;
WDate of Disposition 3ji1,172. Place of Disposition .017n — riy`
i (ad ess)
W
x t (section) d,..., 11o1 number) (grate number)
SName of Sexton or Person in arge of Premises �tl�
Z ( ease print)
W Signature Title Lilf,►1t{r(
DOH-1555(o7/18)p t of 2
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#