Harrington, Merrill Thomas 3-29
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Merrill Thomas Harrington Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/06/2020 77 Years War or Dates
F., Place of Death Hospital,Institution or
Z City,Town or Village Albany Street Address Albany Medical Center Hospital
8J Manner of Death Undetermined Pending
W Natural Cause Accident Homicide Suicide g
U Circumstances Investigation
W Medical Certifier Name Title
Bradford Wllox MD
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City,Town orViUage Albany 0101 0768
Burial Date Cemetery,Crematory or Facility Name
04/09/2020 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
z Removal Date Place Removed
and/or and/or Held
}- Hold Address
N
O
IL Date Point of
fA El Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
i.- Remains are Shipped,If Other than Above
2 Address
cc
W
(L Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/09/2020 Registrar of Vital Statistics Dan.&&Sjillerpie(E&-tronicallySi,ned)
(signature)
District Number 0101 Place Albany, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
i—
WDate of Disposition q�/p Place of Disposition r�
uj (address)
W
N (section) (lot numA -Mmbbe_r) (grave number)
IX
0 Name of Sexton or Person in Char of Premises ^'
(ple a print)
W Signature Title �geo e'
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 013 50 2C'
Receipt
Human remains of delivered on , 20—
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
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