Harrington, Sandra Lynn 31.:-..F A, It -) 2 9
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Sandra Lynn Harrington Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/09/2022 i 71 Years i War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Kingsbury Town Street Address 491 Dean Road,Kingsbury Town, New York 12839
WW Manner of DeathUndetermined Pending
X Natural Cause Accident I (Homicide ESuicide n n
U Circumstances Investigation
W Medical Certifier Name Title
O Curtis Gedney MD
Address
454 Glen Street,Glens Falls,New York 12801
Death Certificate Filed Town Of Kingsbury District Number Register Number
City,Town or Village 1 5762 17
nBurial Date Cemetery,Crematory or Facility Name
09/13/2022 Pine View Crematorium
Entombment Address
X Cremation Queensbury Town, New York
Donation
Z Removal Date Place Removed
and/or and/or Held
t~ Hold Address
N
Cl. Date Point of
U) Transportation
8 by Common Shipment
Carrier Destination
Date Cemetery Address
piDisinterment
Date Cemetery Address
n Reinterment
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
tâ Remains are Shipped,If Other than Above
2 Address
CC
W -- â
â
C' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/12/2022 Registrar of Vital Statistics Cynthia Bardin(ECectronicairy Signed)
(signature)
District Number 5762 Place Town Of Kingsbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
N
WDate of Disposition 1114 1 t Place of Disposition FR...i ZA-. -'
2
(address)
W
CO
CC (section) (lot number/ (grave number/
0 Name of Sexton or Person in Charge of Premises _ 41...., wft
z se print/
W i-T04
Signature Title
DOH-1555(07/18)p 1 of 2
i , ... . ,
1 Public Health Law Sec. 4145(2b)
1
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# ,