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Harrington Sr, Dale NEW YOR`K STA; DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex s Dale Edward Harrington, Sr. Male Date of Death Age If Veteran of U.S. Armed Forces, December 15, 2015 78 War or Dates Korea Place of Death Hospital, Institution or - City, Town or Village Kingsbury Street Address 29 Division St. _ Manner of DeathELI Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined n Pending Circumstances Investigation Medical Certifier Name Title fit Gerald F Abess MD, Address 3 Irongate Ctr. Glens Falls, NY 12801 Death Certificate Filed District Number Register Number City, Town or Village 5 7(e a 1$ ID Burial Date Cemetery or Crematory tom, December 21, 2015 Pine View Crematorium ,--r ❑Entombment Address gs .©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed ❑ Removal and/or Held and/or Address j Hold Date Point of t ❑Transportation Shipment N by Common Destination D Carrier Disinterment Date Cemetery Address IllReinterment Date Cemetery Address ~. Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 '' Name of Funeral Firm Making Disposition or to Whom I— Remains are Shipped, If Other than Above 2- Address t I'.! '`. Permission is hereby granted to dispose of the human rem ins d ribed above as indicated. Date Issued /a•/6•o?0/s Registrar of Vital Statistics `_------ (signature) _� District Number 5-76 Place /�1,4-, ..„ '' I certify that the remains of the decedent identified above were disposed of in accordance' with this permit on: Z12_T/Yei 'r p:),e U G.) L'c i.., t w Date of Disposition 12 21 5 Place of Disposition Quaker Road Queensbury,NY 12804 W' (address) co rt (section) (lot number) (grave number) 0 Name of Sexton or erson in Charge of Premises --11,) ✓t 6G-rn44,1„ /I (please print) Signature .1 Title C.rt_rvi4. o� (over) DOH-1555 (02/2004)