Garrott Sr, Richard 30
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Richard D. Garrett Sr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
July 9,2006 90 War or Dates
Pla • ath City of Fort Edward Hospital, Institution or Fort Hudson Nursing Center Inc.
Z City, I own ,r Village , Street Address
G Manner of Death X Natural Cause ❑ Accident ❑ Homicide ❑ Suicide El Undetermined ❑ Pending
Circumstances Investigation
V Medical Certifier Name Title
a
Address
----0-- L-Arc, y- A \2 23
Death Certificate Filed District Nuinber Regis r Number
City,Town or Village Fort Edward,NY 7.j
❑ Burial Date Cemetery or Crematory
July 11,2006 Pine View Crematorium
❑ Entombment Address
El Cremation Queensbury,NY
Date Place Removed
z 0 Removal and/or Held
• and/or Address
F:. Hold
o Date Point of
a ❑ Transportation Shipment
t/? by Common Destination
G Carrier
Date Cemetery Address
❑ Disinterment
Date Cemetery Address
❑ Reinterment
Permit Issued to Registration Number
Name of Funeral Home Regan&Denny Funeral Home 01519
Address
53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
F,,, Remains are Shipped, If Other than Above
Address
r4
d Permission is he b granted to dispose of the human remai described above a indicated.
Date Issued 7 II/• L Registrar of Vital Statistics
(signature 7_
District Numbe57:: Place Fort Edward,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
Z Date of Disposition 1-i 1-eat. Place of Disposition i1,o; v /1 C' ` rt IN,i t ^ v rl
ILI (address)
W
u) (section) (lot number) (grave number)
O Name of Sexton or Person in Charge of Premises ( 1);,i ' . tf
a
�, (please print)
W Signature 1,',Va. ,4,n_fk_Lbir Title C It m-.TP
DOH-1555 (02/2004) (over)