Harrington, Richard NEW YORK STATE DEPARTMENT OF HEALTH ,4 3 2 Z
Vital Records Section , Burial - Transit Permit
Name First Middle Last Sex
Richard A. Harrington Male
Date of Death Age ( If Veteran of U.S. Armed Forces,
04 / 19 / 2017 89 War or Dates Vietnam
Place of Death Hospital, Institution or
ZCity, Town or Village Saratoga Springs Street Address Saratoga Hospital
0 Manner of Death®Natural Cause E Accident E Homicide E Suicide 0 Undetermined 0 Pending
tii Circumstances Investigation
tu Medical Certifier Name Title
0 Derek Smith MD
Address
211 Church St, Saratoga Springs, NY 12866
Death Certificate Filed District Number `-ttoi Register Number t
City, Town or Village Saratoga Springs .2ri-1
mirnBurial Date Cemetery or Crematory
04 / 20 / 2017 Pine View Crematory
'i fEntombment Address
iiiigi ECremation Queensbury, NY
Date Place Removed
4❑Removal and/or Held
3 and/or Address
Hold
V Date Point of
Q Transportation Shipment
C by Common Destination
iN Carrier
j Disinterment Date Cemetery Address
'. Q Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Sli Address
402 Maple Ave., Saratoga Sp. , NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
it
ILI
"` Permission is ereby granted to dispose of the human remain s 'be�abo ' icated.
Date Issued Li 2D) I-9- Registrar of Vital Statistics ��
(signature)
District Number L{51 Place Saratoga Springs , New York
>> I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
u
Ul Date of Disposition yI21 I1 ) Place of Disposition Art.,,J 1 gioriu—
(address)
tii
i (section) A,(lot number) (grave number)
0
0 Name of Sexton or Person in Charge of Pr mises /+`�� / �401
Lz.
(plse print) •
Signature �'l �` Title (R
(over)
DOH-1555 (02/2004)