Ostrander, Donald NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Donald Floyd Ostrander Male
Date of Death Age If Veteran of U.S. Armed Forces,
December 31, 2011 90 War or Dates i fi y2_(cj ti(p
g}= Place of Death Hospital, Institution or
City, Town or Village Fort Edward Street Address Fort Hudson Nursing Home
Manner of Death R71
Eli Natural Cause Accident El Homicide 0 Suicide 111 Undetermined n Pending
Circumstances Investigation
Medical Certifier Name Title
44.E Philip J. Gara, Dr.
Address
3318 Broadway Fort Edward 12828
Death Certificate Filed Disc NumbRegis ,r�11,umber
City, Town or Village 5 _ C(,,�a y
u❑Burial Date Cemetery or Crematory
January 3, 2012 Pine View Crematory
❑Entombment Address
®Cremation
Date Place Removed
Removal
and/or and/or Held
Hold Address
41 El
Date Point of
Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
RI
'a 0 Reinterment
Date Cemetery Address
Permit Issued to Registration Number
:;t: Name of Funeral Home M.B. Kilmer Funeral Home 01078
Address
136 Main Street, South Glens Falls NY 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
I Permission is re y granted to dispose of the human r ains described above s indicated.
Date Issued/ i Registrar of Vital Statisti -L/
Lel
(signatu
District Number5-7S"31--- Place / / Ju
I certify that the remains of the decedent identified abov ere disposed of in accordance with this permit on:
Date of Disposition 01/03/2012 Place of Disposition i„e V r;lil,,J 61n„f,f iir,,,.,._
(address)
(section) / got number) (grave number)
Name of Sexton orerson in Ch rge of Premises G h r4,� , �i y44C
7141,—
(p/e se print)
Signature Chu p
Title e,
(over)
DOH-1555 (02/2004)