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#