Olden, Lois Il ris
NEW YORK STATE DEPARTMENT OF HEALTH . • Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
LOIS ETHEL OLDEN FEMALE
Date of Death Age If Veteran of U.S.Ar,ied Forces,
02/03/2016 54 War or Dates
1— Place of Death Hospital, Institution
W City, Town or Village City of Albany or Street Address ALBANY MEDICAL CENTER
C Manner of Death Natural ❑ Undetermined ❑ Pending
LLL ® Cause ❑ Accident E Homicide ❑ Suicide Circumstances Investigation '
WMedical Certifier Name Title
Ct KHUSBOO DESAI MD 4
Address
43 NEW SCOTLAND AVE., ALBANY NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 266
Date Cemetery or Crematory
❑ Burial 02/09/2016 PINE VIEW CREMATORIUM
❑ Entombment Address
® Cremation QUEENSBURY, NY
Date Place Removed
Z. Removal and/or Held
Q' ❑ and/or Address
I— Hold
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Q Date Point of
a Transportation Shipment
Cl)! ❑ By Common
p Carrier Destination
❑ Disinterment
Date Cemetery Address
❑ Date Cemetery Address
Reinterment
Permit Issued To Registration Number
Name of Funeral Home CARLETON FH INC 002814
Address
68 MAIN ST., PO BOX 67 HUDSON FALLS NY 12839
Name of Funeral Firm Making Disposition or to Whom
F Remains are Shipped, If Other than Above
II Address
W'
0- Permission is hereby granted to dispose of the human remains descri e a oh,ve astli ated.
Date 02/05/2016 Registrar of Vital Statistics , r 'L i )d
a/0/ r---,
Issued (signature)
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 2-ld`1 G Place of Disposition f ire VI C,rumer4 or
I (address)
w
co
ce (section) (lot number) (grave number)
0
0
Z' Name of Sexton or Person in Charge of Premises J t..,frt2,y Stv,(tds
(please print)
(Signature Title Cfe.)M4+G(
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DOH-1555 (02/2004)