Meade, Harold NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section • l Burial - Transit Permit
t* Name First Middle Last Sex
Harold E. Meade Male
Date of Death Age If Veteran of U.S. Armed Forces,
.: January 2,2012 54 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
VI
Manner of Death X Natural Cause 1 !Accident Homicide Suicide Undetermined Pending
-; Circumstances Investigation
tit Medical Certifier Name Title
John Stoutenberg
Address
102 Park Street,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
E; City, Town or Village Glens Falls 5601
❑Burial Date Cemetery or Crematory
Entombment January 3,2012 Pine View Crematory
Address
❑x Cremation Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
O and/or Address
H Hold
N
O Date Point of
NTransportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
i a Permit Issued to Registration Number
t: Name of Funeral Home Alexander-Baker Funeral Home 00035
Address
° 3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
Hi Remains are Shipped, If Other than Above
S. Address
Biel,
Permission is hereby granted to dispose of the human remains des ib d bo a i ated.
Date Issued 470.5 /2- Registrar of Vital Statistics
(signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition I-L- It Place of Disposition ,h, icy Croy.elfo r w,„,
W (address)
Cl)
OC (section) (lot numt (grave number)
O Name of Sexton or Pers in Charge of remises ( hr,ito ,- J1+44,4 ft
Z (please print)
W Signature Title. C114/1114-Tvtt--
(over)
DOH-1555 (02/2004)