Harpp, EldridA b Za
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last
Sex
Eldrid R. Harpp
Male
Date of Death
Age
If Veteran of U.S. Armed Forces,
09/18/2019
80 Years
War or Dates 59-63
Place of Death
Hospital, Institution or
WCity,
Town or Village Horicon Town
Street Address 6337 State Route 8, Horicon Town, New York 12815
Manner of Death ® Natural Cause Accident Homicide ❑ Suicide Undetermined Pending
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U
Circumstances Investigation
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Medical Certifier Name Title
Paul Bachman MD
Address
9 Carey Road, Queensbury Town, New York 12804
Death Certificate Filed
District Number
Register Number
City, Town or Village Brant Lake
5654
7
Burial
Date
Cemetery, Crematory or Facility Name
09/19/2019
Pine View Crematory
Entombment
Cremation
Address
Queensbury Town, New York
Donation
ORemoval
Date
Place Removed
and/or
and/or Held
0
N
Hold
Address
O
LL
Date
Point of
N
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Transportation
by Common
Shipment
Carrier
Destination
Disinterment
Date
Cemetery Address
jo
Reinterment
17!e7
Cemetery Address
Permit Issued to
Registration Number
Name of Funeral Home Alexander Baker Funeral Home
00037
Address
3809 Main St, Warrensburg, New York 12885
Name of Funeral Firm Making Disposition or to Whom
I—
Remains are Shipped, If Other than Above
Address
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I'
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/19/2019 Registrar of Vital Statistics 4(/ista L ` ood(`ECectronicallySiyned)
(signature)
District Number 5654 Place Brant Lake, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ZDate
of Disposition Place of Disposition ,,.lJ,,,� (r^�-fu<,•—
uJ
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(address)
W
Ncc
/section) t number) (grave number)
Af.i
0
Name of Sexton or Person in Charge of Premises �-- �^`i
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/ (pleas print)
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Signature L� Title ItZF r'�
DO H-1555 (07/18) p 1 of 2
..
Public Health Law Sec. 4145(2b) 012546
Receipt
Human remains of I �; ." ��' d:,vered,.,o n 1 , 20
Pine View Cemetery Representing funeral home named on burial permit
Official Funeral Direct rs Reg. or License # / 6