Harris Sr, Larry NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
La.rr.y..:.:.:...:....:.......................:.....James..-
Date of Death Age If Veteran of U.S: *Forces,
Forces,
War or Dates
2.0.,....:1.9.91........:::.....:. ..:......::...:....5.0 :...::.... : .................:........................::: ::(�..:.::.....................
�a.� Place of Death Hospital, Institution or
W City Tnr.3.C9E y Glens. falls_ Street Address Glens.. . _..Falls.._Hospital:. ...
� ::.:. . ... ..:..:::.:.:.:
Manner of Death El Natural Cause Accident ❑Homicide Suicide Undetermined ending
Circumstances Investigation
W Medical Certifier Name Title
4) S . Richard Spitzer , MD
Address
60 South St . , Glens Falls , NY
iiiiii Death Certificate Filed District Number Register Number
City,Tomn<orWW g Glens Falls 5601 01.2a,
Date Cemetery or Crematory
laBurial May 22 , 1991 Seeley Cemetery
❑Cremation Address
Town of Queensbury , NY
Z Date Place Removed
O'1, 0 Removal and/or Held
F-, and/or Hold ::.:::............:.
Address
N':,
m Date Point of
I' ❑Transportation by Shipment
p l Common Carrier .........:..................:......:.... -::.:: . .....:..:. .::.:
Destination
:
Disinterment Date Cemetery Address
Ei Reinterment Date Cemetery Address
Permit Issued to Registration Number
aa Name of Funeral Firm Carleton Funeral Home Inc . 00310
mi
Address
u.
P.:O .::..:Bo.x 67.:,:.:::68....Ma.in S.T . x.,:::Hud.son Falls ,..::N.Y 12839 ..
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
4' Address
la
Permission is hereby granted to dispose of the human re 'ns described above as indicated.
�
Date Issued / / Registrar of Vital Statistics ,
��
(signature)
Mi District Number 5Bfl1 Place r.i ty of Glans Falls , NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition �_ Place of Disposition �,v�(Loy CeM P�C�(r� � &c sb
2 (address) ) / Game)
ii (section (Ibt number) (grave number)
ca Name of Sexto rson in C of Premises
Z (please pn )
W Signature Title
DOH-1555 (10/89) p. 1 of 2 VS-61