Harrington, Gary NEW YORK STATE DEPARTMENT OF HEALTH S'
Vital Records Section f Burial - Transit Permit
Name First Middle Last Sex
Gary Martin Harrington Male
°
Date of Death Age If Veteran of U.S. Armed Forces,
February 6, 2012 70 War or Dates
Place of Death Hospital, Institution or
'ill`' City, Town or Village Twn of Moreau Street Address 73 White Birch Estates
Manner of Death j Natural Cause ❑ Accident ❑ Homicide El Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
Medical Certifier Name Title
David Mastrianni MD,
Address
1 West Ave Saratoga Springs, NY 12866
;;; Death Certificate Filed District Number Register Number
City, Town or Village
❑Burial Date Cemetery or Crematory
Ki February 10, 2012 _ Pine View Crematorium
❑Entombment r Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
•
t, ❑ Removal and/or Held
and/or Address
Hold Pine View Cemetery
Date Point of
eL 0 Transportation Shipment
1,! by Common Destination
a Carrier
❑ Disinterment Date Cemetery Address
ElReinterment Date Cemetery Address
N 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
41 Name of Funeral Firm Making Disposition or to Whom
-I— Remains are Shipped, If Other than Above
=2 Address
'Ce
W
Permission is hereby granted to dispose of the human rem ' s described boy as indicfted.
Date Issued �-s-/�
Registrar of Vital Statistics K�
�, (signature)
District Number i/6(,2. Place / I- -7 i Lmette.e.ed
.r I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition it Pi?oil- Place of Disposition 44jJr)
<w40i,�
(address)
W
ce, (section) i (lot number (grave number)
Name of Sexton or Per on in Chart,- of Premises r'41 r sSeblytif
(please print)
Signature 4-- ram. Title Cep.'vb1 '--
(over)
DOH-1555 (02/2004)