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Currier, Harry It NEW YORK STATE DEPARTMENT OF HEALTH r--` ( 1 I 141. Vital Records Section Burial - Transit Permit Name First Middle Last Sex Harry Dean Currier Male Date of Death Age If Veteran of U.S. Armed Forces, March 28, 2011 81 War or Dates Korean Place of Death Hospital, Institution or Z City, Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death X Natural Cause Accident ( 'Homicide [ Suicide Undetermined Pending US Circumstances Investigation W Medical Certifier Name Title q Eric Pillemer,MD Address Glens Falls,NY Death Certificate Filed District Number Register Number City, Town or Village Glens Falls,NY 5601 / ❑Burial Date Cemetery or Crematory Entombment March 31,2011 Pine View Crematory Address El Cremation Quaker Road, Queensbury,NY 12801 Date Place Removed Z Removal and/or Held and/or Address H Hold F.-0 0 _ Date Point of N Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address I I Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Sullivan Minahan& Potter 01675 Address 407 Bay Road, Queensbury, NY 12804 Name of Funeral Firm Making Disposition or to Whom i- Remains are Shipped, If Other than Above 2 Address : Permission is hereby granted to dispose of the human remains de cribe ab e as . i ated. Date Issued ©3`29/2cv/ Registrar of Vital Statistics � (signature) District Number 5601 Place Glens Falls,NY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W `�Date of Disposition `1- It Place of Disposition '1 � V�z�.� L� if ro,,,— Ill (address) CO le (section) (lot numb (grave number) pName of Sexton or Person in Charge of Premises it:til � -- t m•fit ' 77-Itykli--Z ' I (please print) Signature Title Omni wi UDR (over) DOH-1555(02/2004)