Osolin, Bett ♦ ...
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NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
H•r. Name First Middle Last Sex
rf '
r Betty M. Osolin Female
rf Date of Death Age If Veteran of U.S. Armed Forces,
f February 2, 2016 82 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address 71 Longview Drive
Manner of Death g Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Harriet Busch MD
r Address
l:
f 161 Carey Road,Queensbury,NY 12804
Death Certificate Filed District Number Register Number
▪ City, Town or Village Queensbury 5657 I 1
.. ❑Burial Date Cemetery or Crematory
February 4, 2016 Pine View Crematory
❑Entombment Address
❑x Cremation Quaker Road, Glens Falls,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
0 Date Point of
O.
Transportation Shipment
p' by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
▪ Permit Issued to Registration Number
:;:, Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
✓ ; 53 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
..'? Remains are Shipped, If Other than Above
Address
it.
1 Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued a/3 I at i t1 Registrar of Vital Statistics -A(.n
ohR.- -fie a tA,..,
(signature)
▪:r
▪ District Number 5657 Place Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition-/i/ Place of Disposition f i IC., V;ova Cfe,mcr orY
111
(address)
Cl)
CC (section (lot number) (grave number)
pName of Sexton or Person in Charge of Premises Orfhle,Y - 1J rf,5
tZ (please print)
Signature,4- -!4, Title C r'GM q-10 r
(over)
DOH-1555(02/2004)