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Harwood, George E. NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital.Records Name First Middle Last Sex George E Harwood Male Date of Death Age If Veteran of U.S.Armed Forces, 01/12/2021 57 Years War or Dates Unknown Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital WW Undetermined Pending Manner of Death ©Natural Cause �Accident �Homicide �Suicide U Circumstances Investigation W Medical Certifier Name Title 0 Michael Miles MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 25 ElBurial Date Cemetery,Crematory or Facility Name 01/16/2021 Pineview Crematory ❑Entombment Address ]Cremation Queensbury Town,New York ❑Donation Z Removal Date Place Removed and/or and/or Held f Hold Address an 0 n. Date Point of Cl) ❑Transportation p by Common Shipment Carrier Destination El Disinterment Date Cemetery Address 12 RelAterment Date Cemetery Address Permitfssued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 2 Address W 0- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/15/2021 Registrar of Vital Statistics Robert Andrew Curtis(Electronically Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 1111 It! Place of Disposition . IL L(d� (address) W CC (section) Illofnumbels (grave number) 0 Name of Sexton or Person in Charge of Premises G 1 f+,M�. ►'^�'��� Z � �� (Pleas}print/ LU �� Title n.Y'*1;�� �"tC Signature DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 14 491 Receipt Human remains of delivered on , 20 { Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#