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Harrington, Rose M SI N EW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Rose M.Harrington Female Date of Death Age If Veteran of U.S.Armed Forces, 01/13/2022 70 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing W Ip Manner of Death © Natural Cause ❑Accident ❑ Homicide ❑Suicide ❑Undetermined ❑Pending C.) Circumstances Investigation Lii Medical Certifier Name Title Wendy Steinhacker PA Address 42 Gurney Ln, Queensbury Town, New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 15 ❑Burial Date Cemetery,Crematory or Facility Name 01/15/2022 Pine View Crematorium ❑Entombment Address ElCremation Queensbury Town,New York ❑ Donation 0 ❑Removal Date Place Removed and/or and/or Held N Hold Address 0 O. Date Point of Cl) ❑Transportation p by Common Shipment Carrier Destination Date Cemetery Address ❑Disinterment ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls, New York 12839 Name of Funeral Firm Making Disposition or to Whom F— Remains are Shipped,If Other than Above Address CC W Cs_ Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/14/2022 Registrar of Vital Statistics Caro tineIli tdegarde Barber(ECectronica[CySigned) (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: F— W Date of Disposition t1/�S In. Place of Disposition )ct 1 2 (address) W CC (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premiss � fii -- ''1'�� Z iilease print) W Signature Title (ix DOH-1555(07/18)p 1 of 2 j 54 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on 1?ui4l permit Official Funeral Directors Reg.or License#