Ogden, Darlene i II 2 CO
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
;; Name First Middle Last Sex
Darlene Marie Ogden Female
Date of Death Age If Veteran of U.S. Armed Forces,
03/20/2018 49 Years War or Dates
• Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
. Manner of Death Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined El Pending
Circumstances Investigation
Medical Certifier Name Title
Jennifer Donovan DO
Address
100 Park St,Glens Falls,New York 12801
y Death Certificate Filed District Number Register Number
to City, Town or Village Glens Falls 5601 143
r'❑Burial Date Cemetery or Crematory• '' 03/23/2018 Pine View Crematory
El Entombment Address
�-Cremation Queensbury Town, New York
Date Place Removed
x ❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
1 by Common Destination
• Carrier _
❑Disinterment Date Cemetery Address
❑Reinterment
Date Cemetery Address
▪u Permit Issued to Registration Number
• Name of Funeral Home Maynard D Baker Funeral Home 01130
° Address
11 Lafayette St,Queensbury,New York 12804
a▪ 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.
`i Date Issued 03/21/2018 Registrar of Vital Statistics qp6ertA Curtis(cl ctronicaltySigned)
g
(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 on:
Date of Disposition 3)7(,11i Place of Disposition .wd,-- i' s c,{,._—
(address)
6tl§
A (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises �ri* �a "�
(pl se print)
Signature `� �t-�' Title /KIM VAL
(over)
DOH-1555(02/2004)