Harpp, Henry NEW YORK STATE DEPARTMENT OF HEALTH • At 3/
Vital Records Section t. • Burial - Transit Permit
Name First Middle Last Sex
Henry Harvey Harpp Male
Date of Death Age If Veteran of U.S. Armed Forces,
01/10/2016 13years War or Dates 1950-1954
1- Place of Death Hospital, Institution or
Z City, TX(X XrXG(D�MX Glens Falls Street Address Glens Falls Hospital
Manner of Death®Natural Cause 0 Accident 0 Homicide 0 Suicide Undetermined Pending
W. Circumstances Investigation
la Medical Certifier Name Title
4t Bradley G Smith, Rpa-c
Address
100 Park St Glens Falls, N Y 12801
Death Certificate Filed District Number Register Number
City, TXXCXXrXXA1ll X Glens Falls 5601 13
❑Burial Date Cemetery or Crematory
01/11/2016 Pine View Crematorium
< i ❑Entombment Address
;;:['Cremation Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
❑and/or
Address
H Hold
In
0 Date Point of
to Li Transportation Shipment
0 by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Edward L. Kelly Funeral Home 00519
Address
Schroon Lake, N Y 12870
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
tr
Il
' Permission is hereby granted to dispose of the human remains described above as indicated.
s Date Issued 01/11/2016 Registrar of Vital Statistics 1'\)CA.A.A .
(signature)
liiiil District Number 5601 Place Glens Falls
certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
f
Z
Ill Date of Disposition I/131 Ib Place of Disposition ZI(J w ( m toc _-
2 (address)
Ili
CA
IC (section) (lot number (grave number)
Ca Name of Sexton or Person in Charge of remises At) Jt"^'*'
Z /// (please print)
I Signature f l Title C1g �
(over)
DOH-1555 (02/2004)