Younes, Harry , 41 (al
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Harry Clayton Younes Male _
Date of Death I Age If Veteran of U.S. Armed Forces,
December 15,2011 I 75 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls I Street Address Glens Falls Hospital
p Manner of Death g Natural Cause Accident Homicide I ]Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
Ct G amal Khljja
Address
Death Certificate Filed District Number I Register Number� �
City, Town or Village Glens Falls 5601 I L i5b
❑Burial Date Cemetery or Crematory
El Entombment December 19,2011 Pine View Crematory
Address
❑x Cremation Quaker Rd.,Queensbury, NY 12804
Date j Place Removed
Z I I Removal I and/or Held
and/or Address
N Hold
O Date Point of
NTransportation - I Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00035
Address
3809 Main Street, Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped, If Other than Above
2 Address
CL
W
a
Permission is hereby granted to dispose of the human remains described� above as indicated.
ZDate Issued! f) 9 /t( Registrar of Vital Statistics C&..AN-n UJ
(signatu
District Number 5601 Place Glens Falls N y
I certify that the remains of the decedent identified above were dispos d of in accordance with this permit on:
flu Date of Disposition p 21 Ip�1 Place of Disposition tnc Vky (. ►forl�ln.(address)
W
N
CC
(section) 1, � (lot number (grave number)
im• Name of Sexton or Pero in Charge of Premises (1fi N+ [T QMtal'
Z 11"" (please print)
W g CqPL.
eM PfiO(L-
Sinature Title
(over)
DOH-1555 (02/2004)