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Ogden, Keith NEW YORK STATE DEPARTMENT OF HEALTH ZS� Vital Records Section '— Burial Transit Permit Name First Middle Last Sex Keith William Ogden Male Date of Death Age If Veteran of U.S. Armed Forces, April 9, 2018 59 War or Dates Place of Death Hospital, Institution or w City, Town or Village Hudson Falls Street Address 23 Elm Street Manner of Death Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending Circumstances Investigation W Medical Certifier Name Title 0 Charles Yun, Address 102 Park Street Glens Falls, NY 12801 Death Certificate Filed District Number Register Number City, Town or Village Hudson Falls 5 7 )-4, -7 ❑Burial Date Cemetery or Crematory April 11, 2018 Pine View Crematory ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z ❑ Removal and/or Held and/or Address F; Hold Date Point of L ❑Transportation Shipment in by Common Destination C Carrier Date Cemetery Address ❑ Disinterment Date Cemetery Address DI Reinterment Permit Issued to Registration Number Name of Funeral Home M. B. Kilmer Funeral Home- FE 01079 Address 82 Broadway, Fort Edward NY 12828 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above i Address W al. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued V/l l // i Registrar of Vital Statistics Ci,ri g- -- (signature) District Number 5 ,i-t Place V,-//4< a -( 4s e n a /45 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IF-`' w Date of Disposition 04/11/2018 Place of Disposition Quaker Road Queensbury,NY 12804 (address) w fs g (section) r iti .(lot numt�er) J� (grave number) Name of Sexton or Person in Charge of Pr mises ^.Ipl.. ..`J'.'��I ,�� lease print) 111 Signature C kr Title (iEma1VL (over) DOH-1555 (02/2004)