Gaugh, Harry NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Harry F. Gaugh..:.: ....:::.. M
Date of Death Age If Veteran of U.S.Armed Forces,
Set 12 1992 .:.:..........::--:. .. .....:..........53 ... _ War or Dates
�:.....:....p... . �.. _ .::...... .:: .. ::::.::..
14 Z Place of Death Hospital, Institution or
W: City,Town or Village Glens Falls Street Address Glens Falls Hospital
..... ....... :::.. .... .... g........ _
G Manner of�DeathX ......::........... ..: .:....... .. : ........................ _...: ...:..... Undetermined Pending
Natural Cause ❑ Accident ❑ Homicide ❑ Suicide
Circumstances Investigation
..... .: ..... .......
.... ....
Medical Certifier Name Title
Q Richard P Leach MD
......... . :: .............................................. . ........... . . --.........
Aress
17 Pine St Glens Falls, NY 12801
.......................................... . ...:: . ..: .:.:::. _. -- _ .... ...........
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 1L
Date Cemetery or Crematory {
❑Burial SEpt 15, 1992 PIneview Crematory
............
EZK,remation . Address
Quaker Rd Queensbury, NY_ 12804
. .
..........::::.................. ........
Z Date Place Removed
,'AI ❑ Removal and/or Held
F—` and/or Hold Address ............ ........:
A
O........................ ...........................................
OL Date Point of
cn ❑Transportation by Shipment
p' Common Carrier ..............:........::_ .. __
Destination
._ _ ..... .:::....................................._ ................ .
El Disinterment Date Cemetery Address
.........................................
...... :: :. ... __ . .. ...... _
❑ Reinterment
Date Cemetery Address _....
Permit Issued to Registration Number
Name of Funeral Firm Tunison Funeral Home INC 01967
.:::... _......... . ..::.........
Address
105 Lake Ave SAratoga Springs, NY 12866
I-: Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
ut
Address
i2>
Permission is hereby granted to dispose of the human �rmains descri , d aboy ,as indicated.
Date Issued Registrar of Vital Statistics r
(signature) -
District Number Irv/ Place
1 certify that the remains of the decedent identified above were disposed o accordance with this permit on:
Z Date of Disposition "� oz Place of Disposition � 4J ��/1�i9iO�/�/
2' (address)
w'
Coll'' (section) (lot number) (grave number)
cc.
O �� �� 4)
p Name of Sexton o Person in C arge of Premise
W (please print) l .�/Yl 7�� SSA r
Signature Title ICJ
DOH-1555 (10/89) p. 1 of 2 VS-61