Olesen, Harry NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
• Name First Middle Last Sex
,,, Harry Patrick Olesen Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/29/2018 71 Years War or Dates
Place of Death` h Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death a Natural Cause E Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Stephen Perazzelli MD
Address
ri 100 Park St,Glens Falls,New York 12801
• Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 159
❑Burial Date Cemetery or Crematory
04/02/2018 Pine View Crematory
Entombment Address
®Cremation Queensbury, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
Transportation _ Shipment
by Common Destination
., Carrier
El Disinterment Date Cemetery Address
• ❑Renterment Date Cemetery Address
cf
gi Permit Issued to Registration Number
Name of Funeral Home Regan&Denny Funeral Service 01444
Address
94 Saratoga Ave,S Glens Falls,New York 12804
084 Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
;:,„ Permission is hereby granted to dispose of the human remains described above as indicated.
-- Date Issued 04/02/2018 Registrar of Vital Statistics qWertA Curtis(E(ectronical(ySigned)
(signature)
District Number 5601 Place Glens Falls, New York
• I certify that the remains of the decedent identified above were disposed of in accordance with this permit qn:
9
IW Date of Disposition 1 I Z jj4 Place of Disposition U N-- C ire-✓
W (address)
Et (section) (lot number) c (grave number)
Name of Sexton or Person in Charge f Premises r» )k.hl
iir
jr (ple se print)
W Signature g Title tiaA►t VYL
(over)
DOH-1555(02/2004)