Harrington, Dorothy NEW YORK STATE DEPARTMENT OF HEALTH - ' p ; 35'7
Vital Records Section Burial - Transit Permit
r' Name First Middle Last Sex
f' Dorothy
� Jean Harrington Female
Date of Death Age If Veteran of U.S. Armed Forces,
fr > May 10,2016 79 War or Dates
' Place of Death Hospital, Institution or
h City, Town or Village Queensbury Street Address 137 Laurel Lane
07 Manner of Death n Natural Cause n Accident Homicide n Suicide n Undetermined I Pending
a Circumstances Investigation
s: Medical Certifier Name Title
Darushan Sooriabalan MD
' Address
161 Carey Road,Queensbury,NY 12804
f �
• De cate Filed District Number Register Number
g.
• Ci Town or illage a
�e �� l, ixdSA �0
❑Burial Date /� Cemetery or Crematory
❑Entombment May 13,2016 V Pine View Crematorium
Address
EI Cremation 51 Quaker Road, Queensbury,NY 12804
Date Place Removed
Z U Removal and/or Held
and/or Address
F' Hold
O Date Point of
es IT Transportation Shipment
a by Common Destination
Carrier
I 1 Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
, Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury,NY 12804 7rj Name of Funeral Firm Making Disposition or to Whom
`' Remains are Shipped, If Other than Above
Address
4
,,, Permission is hereby granted to dispose of the human re s escr a )s indicated.
;� Date Issued .)-t• -i t,,o Registrar of Vital Statistics 10
�
/ _ (signature)
,s: f
District Number �Id5� Place tip Si)u�
6
I certify that the remains of the decedent identified abov were disposed of in ac rd ce with this permit on:
2W Date of Disposition J5hi, It(, Place of Disposition fnl gleraele(address)
co
re (section) (tpt number (grave number)
p Name of Sexton or Person in Charge of Premises dP4
Z 4 (p ase prin
W Signature - Title liPtittrX
(over)
DOH-1555(02/2004)