Harrington, David Daniel , IN 510
NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last . Sex
David Daniel Harrigan Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/15/2023 85 Years War or Dates
F, Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death g
� �Natural Cause Accident �Homicide Suicide Undetermined ❑Pendin
W Circumstances Investigation
W Medical Certifier Name Title
O Gamal Khalifa 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 24
Burial Date Cemetery,Crematory or Facility Name
01/17/2023 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
OZ❑Removal Date Place Removed
and/or and/or Held
I— Hold Address
N
0
O. Date Point of
U) Transportation Shipment
p by Common
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/17/2023 Registrar of Vital Statistics 9MMlegan Wolin(E(ectronica((ySigned)
(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:
I—
Z Date of Disposition I 11911,3 Place of Disposition 1n.lL
2 (address)
W
NCC (section) (lot n tuber) (grave number)
0 Name of Sexton or Person in Charge of mises ease,ry L fl i t
(p P
11.1
/ �J7
Signature Title C ' ����
DOH-1555(07/18)p 1 of 2
1 - ,„.
L 1_6 ..!
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#