Harig, Paul Thomas t )7
NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Paul Thomas Hang Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/12/2021 95 Years War or Dates Navy
Place of Death Hospital,Institution or
IL City,Town or Village Glens Falls Street Address Glens Falls Hospital
Q Manner of Death ❑X Natural Cause D Accident ❑Homicide 0 Suicide ❑Undetermined Pending
Circumstances Investigation
WW Medical Certifier Name Title
David Cunningham MD
Address
3 lrongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 98
ElBurial Date Cemetery,Crematory or Facility Name
02/16/2021 Pine View Crematory
❑Entombment Address
X❑Cremation Queensbury,New York
ElDonation
oz
Removal Date Place Removed
and/or and/or Held
> Hold Address
❑Transportation Date Point of
fl by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
j- Remains are Shipped,If Other than Above
Address
CC
Ill
` Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/16/2021 Registrar of Vital Statistics Rp6ert,?nrlrew arils gectronicall Swner9
(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:
Date of Disposition Zug./11 Place of Disposition !�(lAi
�_
(address)
iV
(section) (!ot umber/ (grave number)
S Name of Sexton or Person in Char remises ((lumber)
t �. w �I
ilease prt/
IU COAi�wf ��
Signature Title
Y
DOH-1555(07/18)p t of 2 "�
Public Health Law Sec. 4145(2b) a -``� '° -
Receipt
Human remains of delivered on , 20
1 Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#