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Harsen, Edward c ) NEW YORK STATE DEPARTMENT OF HEALTH 3V) Vital Records Section Burial - Transit Permit z Name First Middle Last Sex Edward J. Harsen Male ide Date of Death Age If Veteran of U.S. Armed Forces, CM May 20,2017 8+ War or Dates 1951 - 1953 Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death ©Natural Cause pi Accident Homicide n Suicide n Undetermined Pending Circumstances Investigation Medical Certifier Name i. Paul R Filion Title MD :v Address 2 irongate center, glens falls, NY 12801 ;:.O: s City Death Certificate Filed District Number ( Register„ , Town or Village Glens Falls, NY ❑Burial Date Cemetery or Crematory ❑Entombment May 22, 2017 Pine View Crematorium Address ©Cremation 51 Quaker Road, Queensbury, NY 12804 Date Place Removed Zri Removal and/or Held and/or Address E" Hold y aDate Point of N 1 I Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address El Reinterment Date Cemetery Address Permit Issued to Registration Number F? Name of Funeral Home Regan Denny Stafford Funeral Home 01443 60. Address di 53 Quaker Road, Queensbury,NY 12804 Name of Funeral Firm Making Disposition or to Whom I. > Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as in.' •. F}Yi :: Date Issued C6/ � )17 Registrar of Vital Statistics ` J_' _ AV `....4.1. _ /J/, (signature) '` District Number 5�r) / Place _ 14-„Q 7- YJ�� L7 I certify that the remains of the decedent identified above were disposed of in accor nce with this permit on: Z � • gDate of Disposition 51417 Place of Disposition Ent A� `,,t,,,,,c-e.{�,,,,`, W (address) U) 0 Q (section) (lot number) (grave number) ZName of Sexton or Person in Charge of Premises4,5 3c4.1tt ill IL print) Signature !1 ,/ � Title aq.11 70 (over) DOH-1555(02/2004)