Harrington Sr., Stanley NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Stanley Joseph Harrington Sr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
March 4, 2012 84 War or Dates
Place of Death Hospital, Institution or
W City, Town or Village Glens Falls Street Address Glens Falls Hospital
W'I Manner of Death X❑ Natural Cause 0 Accident ❑ Homicide 0 Suicide ElUndetermined 0 Pending
Circumstances Investigation
W Medical Certifier Name Title
CI Michael Layden, bilt
Address
90 South St. Glens Falls, NY 12801
Death Certificate Filed District Number Registerber
City, Town or Village JECOJ
®Burial Date CAmetery orr Cremato
March 8, 2012 YSin„ VV Je�vw
❑Entombment Address
OCremation Li .' �w 4 A..> . sil Rio'
Date Place Removed
z ❑ Removal and/or Held
O and/or Address
E Hold
N Date Point of
ate, 0 Transportation Shipment
(0 by Common Destination
O Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
L 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 451)z Registrar of Vital Statistics LA) c).-A.Ap-42. LA-)
(signature)
District Number 5 k) ) Place 6 (z,, ,1 S du 7
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 3/8/1 2 Place of Disposition Pine View Cemetery
1 (address)
W Hudson Sec. 3 5 2
CO Cd (section) (lot number) (grave number)
0 Name of Sexton or Persoai Charge of Premises Michael Genier
(please print)
Z
W' Signature 's' Title Superintendent
(over)
DOH-1555 (02/2004)