Poster, HaroldN EW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records
A 616
Burial - Transit Permit
Name First Middle Last
Sex
Harold David Poster
Male
Date of Death
Age
If Veteran of U.S. Armed Forces,
09/28/2019
93 Years
War or Dates Navy
II.—
Place of Death
Hospital, Institution or
Z
City, Town or Village Saratoga Springs
Street Address Home of Good Shepherd
W
p
Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending
W
V
Circumstances Investigation
W
Medical Certifier Name Title
Gerard Abess MD
Address
3 Irongate Center, Glens Falls, New York 12801
Death Certificate Filed
District Number
Register Number
City, Town or Village Saratoga Springs
4501
515
Burial
Date
Ttery,Crematory or Facility Name
10/01/2019
View Crematory
Entombment
Address
nCremation
Queensbury, New York
❑ Donation
Z
Date
Place Removed
Removal
and/or Held
H
and/or
Address
asHold
O
IL
Date
Point of
0
p
❑ Transportation
by Common
Shipment
Carrier
Destination
❑ Disinterment
Date
Cemetery Address
❑ Reinterment
Date
Cemetery Address
Permit Issued to
Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home
01596
Address
407 Bay Rd, Queensbury, New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Q
W
I'
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/01/2019 Registrar of Vital Statistics .74- �'arelFranck�iYectronica� Srgner!/
(signature)
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
Date of Disposition !oil Place of Disposition 44'—
Uj Uj
(address)
W
N
IX
(section) // (tot number) (grave number)
0
Name of Sexton or Person in Charge of Premises f'2�
�J (p se print/
W
Signature Title
DOH-1555 (07118) p 1 of 2
Public Health Law Sec. 4145(2b) . V .-*I
012572
Receipt
Human remains of
delivered on 20-it
Pine View Cemetery
Official
Represent hg the funeral home named qn burial permit
Funeral Directors Reg. or License #