Downs, Harrison Hawkes - iLF 4- 10 5
NEW YORK STATE DEPARTMENT OF HEALTH `� ; Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Harrison Hawkes Downs Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/17/2022 76 Years War or Dates 1963-1966
Hospital,Place of Death P l•Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death II Natural Cause Accident Homicide Suicide Undetermined El Pending
W Circumstances Investigation
W Medical Certifier Name Title
G Scott Biasetti MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 639
Burial Date Cemetery,Crematory or Facility Name
12/20/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
55111Removal Date Place Removed
and/or and/or Held
Hold Address
0
O. Date Point of
V/)OTransportation Shipment
p by Common
Carrier Destination
Disinterment 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
2 Address
CC
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/20/2022 Registrar of Vital Statistics Megan Aran(Ekctronicaf Signed
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition /Z-Z Z--z jZ Place of Disposition ) e t L reiv.t_
2 (address)
W
N CC (section) (lot number) (grave number)
O Name of Sexton or Person in Ch /lige of/Preises A 1'fr (1.J--) !�o 0 CI
Z (please print)
W
Signature Title Dlf-F7 4 ---.(—
DO H-1555(o7/i8)p l of 2
1
11 a3
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#