Harrington, Deborah Ann it-
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NEW YORK STATE DEPARTMENT OF HEALTH r Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Deborah Ann Harrington Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/01/2020 65 Years War or Dates
Place of Death Hospital,Institution or
City,Town or Village Queensbury Town Street Address 30 Lupine Lane,Queensbury Town,New York 12804
pManner of Death D Natural Cause El Accident ❑Homicide ❑Suicide 0 Undetermined E Pending
W V Circumstances Investigation
W Medical Certifier Name Title
G Timothy Murphy Coroner
Address
52 HAVILAND AVE,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 201
❑Burial Date Cemetery,Crematory or Facility Name
11/09/2020 Pine View Crematory
Entombment Address
®Cremation Queensbury Town,New York
ElDonation
g El Date Place Removed
Removal and/or Held
�= and/or
N Hold Address
0
Date Point of
(I)• ❑Transportation Shipment
O by Common
Carrier Destination
Date Cemetery Address
0 Disinterment
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
t- Remains are Shipped,If Other than Above
a Address
CC
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/03/2020 Registrar of Vital Statistics Carolnexklegardi•Barbirglectronicadj,Stgn4
(signature)
District Number 5657 Place Queensbury, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I- j� 4....._
Z Date of Disposition I flu 7o Place of Disposition .J...
W (address/
ILI
Q (section) (lot number) (grave number)
8 Name of Sexton or Person in Charge of Pre i s to L S?�„4in
(phse print)
Z C:J' Z �ruA.4�D�
W Signature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) J 1417 9
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#