Ferraro, Harry # 50 (a
NEW YORK STATE DEPARTMENT OF HEALTH p-
Vital Records Section Burial - Transit Permit
•
Name First Middle Last Sex
Harry Francis Ferraro Male
?� Date of Death Age If Veteran_of U.S. Armed Forces,
July 16, 2016 75 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death I XI Natural Cause Accident n Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Shahid Ahmed
0Address
r: 100 Park Street,Glens Falls,NY 12801
▪ Death Certificate Filed District Number Register u r
':• City, Town or Village Glens Falls 5601 �0
❑Burial Date Cemetery or Crematory
Ill Entombment July 18,2016 Pine View Crematorium
Address
El Cremation 51 Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
F_ Hold
M
O Date Point of
O. I 'Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
• Address
,if: 407 Bay Road, Queensbury, NY 12804
: Name of Funeral Firm Making Disposition or to Whom
▪ Remains are Shipped, If Other than Above
r Address
-
.; Permission is her by ranted to dispose of the human emains escribed bove as i F dica d.
:::e.
,�r�� Date Issued �7 �gc�� Registrar of Vital Statistics ���if
si nat re
'•:•�, District Number 5601 Place Glens Falls
!- I certify that the remains of the decedent identified above wer disposed of in accordance with this permit on:
Z
W Date of Disposition .7/ to (i6 Place of Disposition atO teui 4' ro_
W (address)
CO
0 (section) (lot number) (grave number)
Q Name of Sexton or Person in Charge of Premises /h t1-1-,r Sty,,,
Z (plelase print)�j�f
W /�j[/. afm'ANr-'
Signature .� Title
(over)
DOH-1555(02/2004)