Harrington, James NEW YORK STATE DEPARTMENT OF HEALTH A till
Vital Records Section �� Burial - Transit Permit
` Name First Middle Last Sex
James Lee Harrington Male
, Date of Death Age If Veteran of U.S. Armed Forces,
January 22, 2012 76 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death 1 Natural Cause ❑ Accident ❑Homicide ❑ Suicide ElUndetermined ❑ Pending
41/�; Circumstances Investigation
UU:I Medical Certifier Name Title
O Howard Silverberg, MD,
Address
Department of Medicine Fort Edward, NY 12828
Death Certificate Filed District Number Register Number
City, Town or Village 5601 31
❑Burial Date Cemetery or Crematory
January 24, 2012 Pine Vew Crematorium
❑Entombment Address
rcri
' '®Cremation Queensbury,NY 12804
Date Place Removed
• ❑ Removal and/or Held
a and/or Address
ig Hold
t'A Date Point of
cc ❑
Transportation Shipment
th by Common Destination
Er Carrier
ElDisinterment Date Cemetery Address
❑ Reinterment 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
t_ Remains are Shipped, If Other than Above
Address
04.
LU.
CL Permission is hereby granted to dispose of the human remains described above as indicated,
Date Issued //2. e:-/ / i Z Registrar of Vital Statistics Lx;..—&'
(signature)
District Number 5 6(0 ) Place 6 L.v.,,S 1 1 I J Al (•
- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition ((��
W: p )/LS/�� Place of Disposition -(',,4 V4,2.-1 CI -4,ctufiy".
W' (address)
t (section) A (lot number) r (grave number)
O Name of Sexton or Per on in Charg of Premises r,)�'0 11 T Jt n�14
2 L (please print)
Signature ��( Title CQ ma-7-W-
(over)
DOH-1555 (02/2004)