Harrington, Dorothy Grace NEW YORK STATE DEPARTMENT OF HEALTH IC....1.-.!)
_Bureau of Vital RecordsBurial Transit Permit
Name First Middle Last Sex
Dorothy Grace Harrington Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/15/2022 80 Years War or Dates
F— Place of Death Hospital,Institution or
Z City,Town or Village Albany Street Address Albany Medical Center Hospital
LU
p Manner of Death ❑X Natural Cause Accident El HomicideSuicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
a Matthew Derakhshesh MD
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed City Of Albany District Number Register Number
City,Town or Village 0101 1169
X Burial Date Cemetery,Crematory or Facility Name
05/19/2022 Pine View Cemetery
Entombment
_ Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
H Hold Address
U)
0
Q. Date Point of
U)Dransportation
Q 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
1— Remains are Shipped,If Other than Above
a Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/17/2022 Registrar of Vital Statistics (Dan elleS Gi/-espie(Electronically Signed)
(signature)
District Number 0101 Place City Of Albany
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: '' II� � ,/ ,,,,,/
I—
Z Date of Disposition 5. I q _a� P ace of Disposition 9 I Q £ 4(.tQns&1trc r Y y/a 't
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2 (address) V
w -n'1i11 k 159 A ��// 0
NCC (section) (lot number) (grave number)
SName of Sexton or Person in Charge of Pre ' s ,ont7 I e CL. 'c--Ie_4--)-
Z (please print)
W SignatureAii.t;.t. i Title .fit r�e� in-C/)� �C +
DOH-1555(07/18)p 1 of 2 /
Public Health Law Sec. 4145(2b)
l';'915
Receipt
Human remains of . `,-, . ., ,, , , .',. % delivered on ', ,..• ‘. , , 20 ,) ,
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Wiefeniefery
Representing the funeral home named on burial,peirmit
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4:---Official Funeral Directors Reg.or License#
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HARRINGTON 1..._F)
NAME Dorothy Grace Harrington Age: 80
Lot Owner: David & Dorothy Harrington
Lot# Mohawk 1 5 9A Grave# 2
Case: Concrete
Died: 5. 1 5.2 2 Interred: 5. 1 9.2 2
Funeral Home: Baker FH
Cemetery: Pine View