Harrington, Paul NEW YORK STATE DEPARTMENT OF HEALTH 6
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Paul Gardner Harrington Male
Date of Death Age If Veteran of U.S. Armed Forces,
September 21,2012 64 War or Dates Yes-Vietnam Era
Place of Death Hospital, Institution or
Z City, Town or Village Colonie Street Address 1 Erie Street
p; Manner of Death [XI Natural Cause I I Accident Homicide Suicide Undetermined Pending
W - Circumstances Investigation
W Medical Certifier Name Title
C Huy Nguyen,MD
Address
AMCH,43 New Scotland Avenue,Albany,NY 12208
Death Certificate Filed District Number Register Numb r
City, Town or Village City of Albany 0101 1110
❑Burial Date Cemetery or Crematory
Entombment September 26,2012 Pine View Crematorium
Address
❑Cremation Queensbury, NY
Date Place Removed
Z Removal and/or Held
O and/or Address
F' Hold
co
0 Date Point of
I I Transportation _ Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Date CemeteryAddress
Reinterment
=i'E Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home,Inc. 00281
Address
68 Main Street, PO Box 67,Hudson Falls,NY 12839
Name of Funeral Firm Making Disposition or to Whom
i— Remains are Shipped, If Other than Above
Address
re
a
Permission is hereby granted to dispose of the huma mains '' es 'bed above as indicate G
Date Issued 09/23/2012 Registrar of Vital Statistics may" 1 c=3.r.- i p Z 2
(signatu(7177
District Number 0101 Place City of Albany
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z �
LU Date of Disposition `t f ntIZ Place of Disposition 214 0,e Cith- d r,J.
W (address)
CD
a
0 (section) (lot nu (grave number)
p Name of Sexton or Pers n in Charge of Premises didl ,� ..... ►V
Z I (please print)
W Signature .......L. Title ((Ai vvi R-
over)
DOH-1555 (02/2004)