Harrington, Ethel # ZO
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Ethel Catherine Harrington Female
Date of Death Age If Veteran of U.S. Armed Forces,
11/29/2017 82 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Death 0 Natural Cause Accident E Homicide El Suicide Undetermined TIPending
Circumstances Investigation
Medical Certifier Name Title
John Koella MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 603
El Burial Date Cemetery or Crematory
11/30/2017 Pine View Crematory
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
El Disinterment Date Cemetery Address
sq�ft:
Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079
Address
82 Broadway,Fort Edward,New York 12828
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/30/2017 Registrar of Vital Statistics John2'clranck fCectronicaaySigned'
(signature)
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition /2't / 17 Place of Disposition �U...� awc.A* --
(address)
(section) / lot number) c (grave number)
Name of Sexton or Person in Charge of P mises tLb► Le- J ,1iu'r
(plese print)
Signature -��' V Title `i►Vrt
9
(over)
DOH-1555(02/2004)