Mates, Harold L NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Harold
Louis Mates male
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Date of Death Age If Veteran of U.S.Armed Forces,
December 28, 1991 77 War or Dates World War II
I- _:.....::. ..::... . ..... ..:.................:. .........:...........::.:.................................................................
:Z Place of Death Hospital, Institution or
[ #' City,Town or Village Village of So. Glens Fa lStreet Address 8 Charles Street
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J.G Manner of Death rv11 Natural Cause ❑ Accident ❑ Homicide Suicide Undetermined Pending
L.. uJ Circumstances Investigation
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Medical Certifier Name Title
p William Tedesco MD
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Address
3 Irongate Center, Glens Falls, N. Y. 12801
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. .............................. 9 Death Certificate Filed District Number Re Register Number
City,Town or Village City of Glens Falls
Date Cemetery or Crematory
❑Burial December 30,. 1991 Pine...View...Crematory......... .::..:.
®Cremation Address
Queensbury, New York 12804
Z Date Place Removed
,'OI', Removal a and/or Held
F-' and/or Hold .. ........ .... ........ .:. . ....... ...........
Address
. . ............................................................................ ... . ...:::_ ...................................
d> Date Point of
Ln ❑Transportation by: Shipment
p Common Carrier .:::.
Destination
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Disinterment Date Cemetery Address
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Reinterment Date Cemetery Address
El
Permit Issued to Registration Number
Name of Funeral Firm Regan and Denny Funeral Service, Inc. 01602
_: __..............: _ .. ......... .......
Address
26 Quaker Road, Queensbury, New York 12804
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Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
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;.::.Address
ALL
Permission is hereby granted to dispose of the k i a s scri d above as indicated.
Date Issued �a�' �`�� Registrar of Vital Statistics
i atur
District Number Place /e
I certify that the remains of the decedent identified abiZe were disposed of in accordance with this permit on:
Z Date of Disposition !/ Place of Disposition / /�� !//•��-/ ��.�.y?�9T�iC��l
2 (address)
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N' (section) (lot number) (grave number)
cc
n' Name of Sexton c Person in arge of Premi es .�.al.Ji'4/'t
Z (please print) i
LU Signature )4=36.dbC
Title
DOH-1555 (10/89) p. 1 of 2 VS-61