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Farrington Jr., Donald NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Donald E. Farrington,Jr. Male Date of Death Age If Veteran of U.S. Armed Forces, November 22, 2013 66 War or Dates i.. Place of Death Hospital, Institution or Z City, Town or Village Glens Falls Street Address 59 Fifth Street p Manner of Death 0 Natural Cause n Accident I 1 Homicide n Suicide Undetermined n Pending W Circumstances Investigation W Medical Certifier Name Title Darci Gaiotti-Grilebs MD Address 102 Park St,Glens Falls,NY 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 _//1111 (V ©Burial Date Cemetery or Crematory November 25, 2013 Pine View Cemetery ❑Entombment Address ❑Cremation Quaker Road Queensbury, Queensbury,NY 12804 Date Place Removed z C Removal and/or Held and/or Address NF' Hold 0 Date Point of Transportation Shipment p by Common Destination Carrier n Disinterment Date Cemetery Address n Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Road, Queensbury,NY 12804 Name of Funeral Firm Making Disposition or to Whom I-- Remains are Shipped, If Other than Above 2 Address 0- Permission is h reby granted to dispose of the human remiss des ribed abo as indicat Date Issued O Registrar of Vital Statistics p sign ure) District Number 5601 Place Glens Falls I certify that the remains of the decedent identified abov were dispose of in accordanc with this permit on: w Date of Disposition )/ Z. - 13 Place of Disposition �i1?t,� f- �s' -t• Y 1 u, W (a8�dress) 1 CO 6��O 14(.40 (��J [ ction) (lot number) (grave number) p Name of Sexton or Person in Charge of Premises U500I.6 a :btk7- Z ( lease . I Signature reltAAXtom- a Title / o (over) DOH-1555(02/2004)