Coon, HarryNEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Male
Harry Joseph Coon
Date of Death Age If Veteran of U.S. Armed Forces,
10/15/2019 75 Years War or Dates Unknown
Place of Death Hospital, Institution or
Street Address orMedical Center Hospital
Z
W
Q
City, Town or Village Albany
Manner of Death Undetermined Pending
h
0 Natural Cause Accident Homicide Suicide
Investigation
W
Circumstances
WMedical
Certifier Name Title
Q
Tara Fitzgerald NP
Address
43 New Scotland Ave, Albany, New York 12208
Register Number
2228
7:� Death Certificate Filed =Disteict
City, Town or Village Albany
Burial Date Cemetery, Crematory or Facility Name
10/18/2019 Pine View Crematory
Entombment
Address
Cremation Queensbury Town, New York
Donation
Z
Date Place Removed
Removal and/or Held
and/or
Hold
Address
N
dDate
Point of
to
Transportation
Shipment
p
by Common
Carrier
Destination
Disinterment
Date
Cemetery Address
IFJ 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
Ir
Remains are Shipped, If Other than Above
2
Address
cc
Ii]
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/18/2019 Registrar of Vital Statistics Dance&SCjrfe-(E&trvnka-5Srgned)
(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:
Z
Date of Disposition 10111 Ili Place of Disposition
tu
tu
/address/
W
N
(section) (lot number) (grave number/
� S4a na ~ Name of Sexton or Person in Charge of Premises
Z
(p/e se print)
W
Signature Title f-
DOH-15
,5 (07/18) 01 of 2
Public Health Law Sec. 4145(2b)
113 019
Receipt
Human remains of
6P' " e View Cemetery
fficial
delivered on
, 20
Re&esenting the funeral home named on burial permit
Funeral Directors Reg. or License #� ` `''