Osgood, April NEW YORK STATE DEPARTMENT OF HEALTH f : 7r b b
Vital Records Section Burial - Transit Permit
V Name First Middle Last Sex
April Osgood Female
Date of Death Age If Veteran of U.S. Armed Forces,
08/31/2017 64 Years War or Dates
• Place of Death Hospital, Institution or
• City, Town or Village Ballston Spa Village Street Address Saratoga Center for Rehab and Skilled Nursing
A. Manner of Death X❑Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
w Jose Nebres MD
q Address
149 Ballston Ave,Ballston Spa Village,New York 12020
A Death Certificate Filed District Number Register Number
City, Town or Village Ballston Spa Village 4520 58
. ," ❑Burial Date Cemetery or Crematory
09/01/2017 Pine View Crematory
❑Emiintombment
g. Address
y Cremation Queensbury Town, New York
'''' ri i
Date Place Removed
Removal and/or Held
and/or Address
Hold
14- Date Point of
Fart❑Transportation Shipment
by Common Destination
Carrier
❑Disinterment
Date Cemetery Address
kl
x -❑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
f Name of Funeral Firm Making Disposition or to Whom
_;:� Remains are Shipped, If Other than Above
aKK Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/01/2017 Registrar of Vital Statistics Teri Lee()Connor cEfectronicaaySigned'
710 (signature)
115.
; District Number 4520 Place Ballston Spa Village, New York
;
N' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 9 I sin Place of Disposition ft,Att,/ 4,-4 o n�h.
(address)
(section) At (lotrumber) (grave number)
Name of Sexton or Person in Charge f Premises U`-•.j ,s' A�`
(lease print)
. Si nature 6 14 Title Pitt
(over)
DOH-1555 (02/2004)