Harrington, Michael t v iti 3c5"
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Michael J. Harrington Male
Date of Death Age If Veteran of U.S. Armed Forces,
May 26,2016 64 War or Dates
Place of Death Hospital, Institution or
• City, Town or Village Glens Falls Street Address Glens Falls Hospital
tti
Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
.11t Circumstances Investigation
F , Medical Certifier Name Title
.0 Darci Ann Gaiotti-Grubbs
Address
_' 102 Park St.
Death Certificate Filed District Number �� Register Number
City, Town or Village 5 i7U
❑Burial Date Cemetery or Crematory .
May 27,2016 Pine View Crematory
Ill Entombment Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
Cl)
O Date Point of
N I I Transportation Shipment
aby Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
°: Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
MI
It
,. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued S j -• / ( L-, Registrar of Vital Statistics L'J CA�✓Yy•\ . emu'^�\-'C
(signature)
District Number 5 6,C ) j Place 6 M $ t--t.A 1 1 / iv
I certify that the remains of the decedent identified above were disposed of in accordancer with this permit on:
W Date of Disposition SOMA) � 'J Place of Disposition 1_.' (L. 6.—
W i (address)
cn
(section) (loi number)(-- (grave number)
Q Name of Sexton or Person in Charge Premises Li 11��L .,
Z ?lease print)
W Signature 6 Title aelii-94.
(over)
DOH-1555 (02/2004)