Harrington, Charles 4 • r
'i -3
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Charles Richard Harrington Male
fil Date of Death Age If Veteran of U.S.Armed Forces,
04/19/2018 82 Years War or Dates
Place of Death Hospital, Institution or
75
till City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death Natural Cause 0 Accident 0 Homicide 0 Suicide Undetermined Pending
iiil Circumstances Investigation
Medical Certifier Name Title
Marvin Davidowitz MD
ipta Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
til City, Town or Village Glens Falls 5601 203
❑Burial Date Cemetery or Crematory
04/23/2018 Pine View Crematory
0❑Entombment Address
gal®Cremation QueensburyTown, New York
Date Place Removed
Removal and/or Held
and/or Address
Hold
Date Point of
Transportation41 Shipment
by Common Destination
Carrier
} Disinterment
Date Cemetery Address
Q Reinterment
Date Cemetery Address
Permit Issued to Registration Number
, Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077
'' Address
123 Main St,Argyle,New York 12809
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
r.!,
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/20/2018 Registrar of Vital Statistics Men A Curtis(E(ectronicalTySigned)
NI (signature)
torj
District Number 5601 Place Glens Falls, New York
r,.... I certify that the remains of the decedent identified above were disposed of inaccordance with this permit on:
Date of Disposition 412y(IY Place of Disposition ' U.,- ire► io./
prill (address)
e (section) /Q� (lot number) (grave number)
Name of Sexton or Person in Charge of Premises
1 jM,dll
( ease print)
Si nature Ad tr TitletOr it '
(over)
DOH-1555 (02/2004)