Millis, Barbara L ( LFY.
7-)0
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Barbara L Millis Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/07/2022 85 Years War or Dates
�.. Place of Death Hospital,Institution or
WCity,Town or Village Corinth Town Street Address 123 Comstock Road,Corinth Town,New York 12833
p Manner of Death El Natural Cause Accident El Homicide Duicide Undetermined ri Pending
UCircumstances Investigation
WO Medical Certifier Name Title
Jamie Bovair NP
Address
325 Main Street,Hudson Falls Village,New York 12839
Death Certificate Filed Town Of Corinth District Number Register Number
City,Town or Village 4553 21
Burial Date Cemetery,Crematory or Facility Name
12/10/2022 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
DRemoval Date Place Removed
and/or and/or Held
p
N Hold Address
0
O. Date Point of
U)❑Transportation
p by Common Shipment
Carrier Destination
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
Remains are Shipped,If Other than Above
„2 Address
t
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/09/2022 Registrar of Vital Statistics Brenda L Peris(Electronically Signed)
(signature)
District Number 4553 Place Town Of Corinth
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition /,/p-h'2Place of Disposition r! e J:Pt,,,
2 (address)
W
COCC (sectiod (lot num ) (grave number)
gName of Sexton or Person in Cha remises k. faG
please print)
IL Signature /1 Title
DOH-1555(07/18)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#