Harrington, Owen Riley 0/0
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Owen Riley Harrington Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/30/2021 14 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
W
p Manner of Death Natural Cause 0 Accident Homicide ❑Suicide ❑Undetermined ❑Pending
W Circumstances Investigation
0
W Medical Certifier Name Title
0 Timothy Murphy Coroner
Address
52 Haviland Avenue,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 319
❑Burial Date Cemetery,Crematory or Facility Name
08/05/2021 Pine View Crematory
Entombment Address
X❑Cremation Queensbury Town,New York
EIDonation
ZO ❑Removal Date Place Removed
and/or and/or Held
Hold Address
0
n- Date Point of
to ❑Transportation
0 by Common Shipment
Carrier Destination
EIDisinterment Date Cemetery Address
•
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
CC
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/02/2021 Registrar of Vital Statistics $'p6ert.,z7n'1rew Curtis.(E/ctronical61Si,ned)
(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:
tZL Date of Disposition 91141,1 Place of Disposition
2 (address)
W
CO
CC (section) A (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premise n
Z (p/eate print)
W Signature Title r
H g
DOH-1555(07/18)p 1 of 2
1,) r'0 4
�R
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#