Harvey Sr., Charles NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Biostatistics -Vital Records Section
Name First Middle Last Sex
Charles George Harvey, Sr. Male
. .Date:o:::::: ................................................... ....................... ........ ..............................................................................
''' f Death Age If Veteran of U.S.Armed Forces,
3/06/87 62 War or Dates WW II
iz Place of Death Hospital, Institution or
City,la Town or Village Town of Queensbury 9 Q Y Street Address 2 Luzerne Rd.
.. ......Ca.
use of Death
44 Acute myocardial infarction
................................
l Medical Certifier Name Title
i.O... S. Richard Spitzer, M.D.
Address•::::•:...............................................................................................................................................................................................--
Box 149, 90 South St. , Glens Falls, NY 12801
Death ................................ .. .............................................. ...........................
Certificate Filed District Number Register Number
iin City,Town or Village`` `1 C, ,s)a,.) ,S (o s? //
Date 3/09/87 Cemetery or Crematory
El Burial Pine Crematorium
®Cremation
Address
- Town of Queensbury, New York
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z• Date Place Removed
10 ❑ Removal and/or Held
'�''' and/or Hold>:.::
Address
N
�. Date Point of
N ❑Transportation by': Shipment
Common ......:::::::::::::::::::::::::::::::::::::,:,::::::::::::::::::::::::::::;>.:::::::::::::::::::::::::::::::::::::::::::::::::::::::::.....:::.:::::::::::::.:.::::.........................
;�; Carrier •Destination
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❑ Disinterment Date Cemetery Address
.......................................:.:>:::Date .................................................... ... ... ................................................................... ......................................
gg El Reinterment
Cemetery Address
•
Permit Issued to Registration Number
Name of Funeral Firm Regan & Denny, Inc. 02883
Address .....................................................::..:::::::::::::::::::::::::::.::::::::::::.�:::::::::::.:::,:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
Quaker Rd. , Glens Falls, NY 12801
Name::: Fu.:::::. . ...............
;, ofneral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
..................................................................................................................
Address
:if::
Permission is hereby granted to dispose of the dead hu n remains desc e ab ve as indicated.
Date Issued 3 5' c.7 Registrar of Vital Statistics l>2 /
(signature)
District Number '�(s S1 Place �' t (9_, .G-„
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„„„„„„
I certify that the rem ins of the decedent identified above were disposed of in accordance with this permit on:
wDate of Disposition I d`7 Place of Disposition /f .)-- - r,' ��T, e.r d r'a � ) /ailA--Qc,i.tz,__q 4&I
s4 ^ (address)
.W',
CC! (section) (lot number) (grave number)
p Name of Secton Person in Charge of Premises 1/,t /)a S
Z I ,� (please print)
W Signature _._». 1� .4---g._ Title , r t__ G'
DOH- 1555 (9/86)p 1 of 2(formerly VS-61)