Millington, Grechen L NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Gretchen L.Millington Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/10/2023 74 Years War or Dates
F- Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
111
W Manner of Death ❑X Natural Cause IllAccident ❑Homicide ESuicide Undetermined El Pending
Circumstances Investigation
W Medical Certifier Name Title
O Christopher Smith MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 20
Burial Date Cemetery,Crematory or Facility Name
01/13/2023 Pine View Crematory
Entombment Address
oCremation Queensbury Town,New York
Donation
❑Removal Date Place Removed
and/or and/or Held
- Hold Address
0
Date Point of
Cl)OTransportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
❑Disinterment
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
p.. Remains are Shipped,If Other than Above
2 Address
CC
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/12/2023 Registrar of Vital Statistics (Megan Noiin(E(ectronicalTy Signed)
(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:
Z Date of Disposition //9-ZoZ3 Place of Disposition tj e ereTY14,4 r�
2 (address)
W
CC (section) _ (lot number) A (grave number)
Name of Sexton or Person in Charge remis s
1c)A�mav� oo
(please print/
Signature Title
DOH-1555(07/18)p 1 of 2
r
Public Health Law Sec. 4145(2b)
ti l c 6
Receipt
Human remains of delivered on , 20
Pine View Cemetery_ Representing the funeralhome named on burial permit
Official Funeral Directors Reg. or License#