Harrington, Muriel NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Muriel M.Harrington ' Female
Date of Death Age If Vete f U.S. Armed Forces,
03/03/2018 96 Years War or Dates
Place of Death _ Hospital, Institution or
City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation
Lics Manner of Death ki Natural Cause 0 Accident 0 Homicide El Suicide 7 Undetermined Pending
411
Circumstances Investigation
Medical Certifier Name Title
Kenneth France MO
Address
170 Warren St,Glens Falls,New York 12801
ro
Death Certificate Filed ( istrict Number Register Number
Cit , Town or Village Glens Falls ,601 122
OBurial Date I Cemetery or Crematory
03/06/2018 J Pine View Crematory
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
0 Removal and/or Held
and/or
Address
ti
Hold
Date Point of
® Q Transportation Shipment
rp by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Ctii
A; Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
i
>u Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/06/2018 Registrar of Vital Statistics 4?p6ert_A Curtis(ECectronica1TySigned)
(signature)
District Number 5601 Place Glens Falls, New York
2 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 3- )-t p Place of Disposition I ;ne' V,tit/ C.,4eMa ley
(address)
®1 (section) (lot number) (grave number)
QName of Sexton or Person in Charge of Premises T�riik,- ,y ;NJ-S
(please print)
11 Signature 4; Title Gr r 71c t"
(over)
DOH-1555 (02/2004)