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Hara, Hugh Gerald MD if NEW YORK STATE DEPA RTMENT HEALTH Burial of Vital Records - Transit Permit Name First Middle Last Sex Hugh Gerald Hare MD Male Date of Death Age If Veteran of U.S.Armed Forces, 01/09/2022 87 Years War or Dates (— Place of Death Hospital,Institution or §tiity,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc annerof Death ©Natural Cause El Accident Homicide ❑Suicide ❑Undetermined El Pending RI O Circumstances Investigation Ui Medical Certifier Name Title 0 Elizabeth Bessette NP Address 319 Broadway,Fort Edward Town,New York 12828 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 4 Burial Date Cemetery,Crematory or Facility Name 01/11/2022 Pine View Crematory 12 Entombment Address 12 Cremation Queensbury Town,New York ElDonation ZZ Removal Date Place Removed o and/or and/or Held F- Hold Address to 0 O. Date Point of 0 LI Transportation p 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 101596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom F Remains are Shipped,If Other than Above 2 Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/11/2022 Registrar of Vital Statistics Aimee G Mahoney(E(ectronica1Ty Signed) (signature) District Number 5755 Place Fort Edward, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z Date of Disposition j IN 12l Place of Disposition `17n J L.� (.tin,,,_.. 2 (address W Er N (section) C7 (lot number) (grave number) gName of Sexton or Person in Charge of Premises (4 L-- S &tit z y /P/eae print/ �^W Signature ... Title G�%A�}I0r� DOH-1555(07/18)p 1 of 2 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#