Millington, Helen A e CiF, # loot
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Helen A Millington Female
Date of Death Age If Veteran of US.Armed Forces,
12/18/2022 87 Years War or Dates
i,,. Place of Death Hospital,Institution or
WCity,Town or Village Northumberland Town Street Address 305A Lindsay Road,Northumberland Town,New York 12831
p Manner of Death ❑X Natural Cause Accident Homicide Suicide FlUndetermined El Pending
W I (Circumstances 'Investigation
W Medical Certifier Name Title
o Jennifer Borden MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed Town Of Northumberland District Number Register Number
City,Town or Village 4563 23
Burial Date Cemetery,Crematory or Facility Name
12/20/2022 Pineview Crematory
Entombment Address
aCremation Queensbury Town,New York
Donation
z❑Removal Date Place Removed
and/or and/or Held
F- Hold Address
N
0
Date Point of
f/)❑Transportation Shipment
p by Common
Carrier Destination
O
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
Address
7 Sherman Ave,Corinth,New York 12822
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
g Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/20/2022 Registrar of Vital Statistics Denise D Murphy(Electronically Signed)
(signature)
District Number 4563 Place Town Of Northumberland
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
f—
W Date of Disposition i 7170 In_ Place of Disposition PAL _
(address)
CC (section) /i(lot number) (grave number)
g Name of Sexton or Person in Charge of Premises //' �—
It
ZZ ` � (plepa
W r��mW l
Signature l
DOH-1555(07/t8)p 1 of 2
•
Public Health Law Sec. 4145(2b)
�.r1 �r5
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#