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Allen, Harriet R.
If fo-lq NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Harriet R.Allen Female k:P� Date of Death Age If Veteran of U.S.Armed Forces, 09/29/2020 88 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital `p Manner of Death © Natural Cause ❑Accident El HomicideEl Suicide0 Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title O Sean Bain MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 441 QBurial Date Cemetery,Crematory or Facility Name 10/01/2020 Pine View Crematory EiEntombment Address X❑Cremation Queensbury Town,New York ❑Donation Z 0 Date O Removal Place Removed and/or and/or Held CO Address 0 a' Date Point of co ❑Transportation p by Common Shipment Carrier Destination ElDisinterment Date Cemetery Address - Reinterment Date 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 j-• Remains are Shipped,If Other than Above 2 Address M W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/01/2020 Registrar of Vital Statistics Wp6ert Andrew Curtis(Electronically Signed) (signature) District Number 5601 Place Glens Falls, 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 'o/1170 Place of Disposition R�IL (A<____ 2 (address) W c (section) Alt-, numbe (grave number) O Name of Sexton or Person in Charge of Premises A. 1N(pprint) W Signature Z" Title ar4rt IVYZ.. DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# f