Flynn, Harold NEW YORK STATE DEPARTMENT OF HEALTH .4 ,ti # /P
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Harold M. Flynn Male
Date of Death Age If Veteran of U.S. Armed Forces,
February 27,2014 89 War or Dates World War II
1; Place of Death Hospital, Institution or
Z` City, Town or Village Queensbury Street Address Westmount Health Care Facility
Ili
0.; Manner of Death X Natural Cause Accident r I Homicide Suicide Undetermined [ Pending
tit; Circumstances Investigation
tu Medical Certifier Name Title
Roslyn Socolof
Address
100 Broad St.,Glens Falls,NY 12801
• Death Certificate Filed District Number Regist�Number
City, Town or Village Queensbury 5657 ��
❑Burial Date Cemetery or Crematory
March 3,2014 Pine View Crematory
0 Entombment Address
®Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
O —and/or Address
E- Hold
N
0 Date Point of
N U Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00035
Address
a 3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
1; Remains are Shipped, If Other than Above
2 Address
MI
4.
Permission is hereby granted to dispose of the human re ai s descri d a ve as indicated.
Date Issued_i 3 (�-J Registrar of Vital Statistics C . L ----___
(signature)
,'' District Number 5657 Place Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
�
S)Date of Disposition 3� 4 Place of Disposition 'Falk,'
(address)
IL
u)
CC (section) (lot numb (grave number)
pName of Sexton or Person in Charge of Premises os s vi j
Z ( ease print)
w Signature .4_ Title CaElIPFrat
(over)
DOH-1555 (02/2004)