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Millington, Ellen M (2) LF cSz NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Ellen M.Millington Female Date of Death Age If Veteran of U.S.Armed Forces, 07/12/2022 78 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Warrensburg Town Street Address 264 River Street,Warrensburg Town, New York 12885 p Manner of Death Natural Cause Accident Homicide Ej Suicide Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title G Paul Bachman MD Address 9 Carey Rd,Queensbury Town,New York 12804 Death Certificate Filed Town Of Warrensburg District Number Register Number City,Town or Village 5660 13 Burial Date Cemetery,Crematory or Facility Name 07/14/2022 Pine View Crematory Entombment Address JJCremation Queensbury Town,New York Donation ❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 O. Date Point of N❑Transportation p by Common Shipment Carrier Destination 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 St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 2 Address LC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/13/2022 Registrar of Vital Statistics Pamela M Ltyd.(ECectronica1 y Signed) (signature) District Number 5660 Place Town Of Warrensburg I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H u , Z Date of Disposition I lL Place of Disposition Fu 2 (address) W LC N (section) (lot number) (grave number) gName of Sexton or Person in Charge o remises bW � *ease print/ W Signature Title ��F�WTA2 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 1 1 1 Receipt Human remains of 1 1 r.1 del,vered on ` , 20 _ f Pine View Cemetery Representing the funeral home named,9.11 lzurial permit Official Funeral Directors Reg.or License#