Harris, Geraldine -14 11
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Geraldine E. Harris Female
Date of Death Age If Veteran of U.S. Armed Forces,
01/31/2012 87 years War or Dates
}- Place of Death Hospital, Institution or
City, TowlikniftWX Saratoga Springs Street Address Wesley Health Care Center, Inc.
Ut
a Manner of Death❑Afatural Cause 0 Accident Ei Homicide El Suicide ri Undetermined ri Pending
W Circumstances Investigation
la Medical Certifier Name Title
Austin Tsai M D
Addr .s
e1�31 Lawrence St., Saratoga Springs, N Y
Death Certificate Filed District Number Register Number
>: City, TowN it XX Saratoga Springs 4501 45
: El Burial Date Cemetery or Crematory
02/06/2012 .Pine View Cemetery
❑Entombment Address
❑etemation Queensbury N Y
Date Place Removed
Z Removal and/or Held
In
and/or
F Address
Hold
C. Date Point of
Q Transportation Shipment
a by Common Destination
Carrier •
Q Disinterment Date Cemetery Address •
mQ Reinterment Date Cemetery Address
ilPermit Issued to Registration Number
Name of Funeral Home Regan & Denny 01443
:: Address
53 Quaker Road, Queensbury, New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
CC
iti.
Permission is hereby granted to dispose of the human remit' de ri d abq 'ndicate .
Date Issued 02/01/2012 Registrar of Vital Statistics r�e
(signature)
District Number 4501 Place Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
la Date of Disposition f , 6, tot2 Place of Disposition -(';,k lit4.4 C r/►rc f or,w.►
(address)
UI
0
CC (section) ,j (lot num� (grave number)
i Name of Sexton or P son in Char a of Premises c c\ I r- rmr0}f
Z (please print)
Signature Title �Q ,p
g ��— �rnflr�
(over)
DOH-1555 (02/2004)