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Karaka, Harold Edward NEW YORK STATE DEPARTMENT OF HEALTH P 370 Vital Records Section a Burial - Transit Permit Name First Middle Last Sex Harold Edward Karaka Male Date of Death Age If Veteran of U.S. Armed Forces, 04/06/2020 88 years War or Dates 1948-1952 Place of Death Hospital, Institution or 4Rkxjfown or* X Halfmoon Street Address 76 Ridgewood Drive, Halfmoon N Y Manner of Death©,Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending 0 Circumstances Investigation Medical Certifier Name Title Kevin B. Costello, M D Address 178 Washington Avenue Extension, Albany, New York 12203 Death Certificate Filed District Number Register Number Jiown or v�ilx Halfmoon 4559 25 El Burial Date Cemetery or Crematory 04/08/2020 Pine View Crematorium []Entombment Address [Cremation Queensbury, N Y Date 'lace Removed ❑Removal and/or Held and/or Address Hold 0 Date Point of & Transportation .0 ❑ p Shipment by Common Destination Carrier ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Road, Queensbury, N Y 12804 Name of Funeral Firm Making Disposition or to Whom 14 Remains are Shipped, If Other than Above '! Address Uj �" Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/08/2020 Registrar of Vital Statistics (signature) District Number 4559 Place Halfmoon certify that the remains of the decedent identified above were disposed of in accordance with this permit on: LU Date 1,4 r� of Disposition q 1i Ito Place of Disposition ,M�,� � 2 (address) Iu 0 M (section) (lot number) (grave number) Name of Sexton or Person in Charge of P emises " (p16Abe print) Signature Title fGsK� (over) DOH-1555 (02/2004) Public Health Law Sec. 4145(2b) 013516 Receipt Human remains of j;` r delivered on '; �' , 20 a Pine View CemeteryRepresenting the funeral home named on burial permit Official Funeral Directors Reg.or License#