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Olden, Patricia A . 1 NEW YORK STATE DEPARTMENT OF HEALTH Ill Vital Records Section Burial - Iran it Permit Name First Middle Last Sex Patricia R. Olden Female Date of Death Age If Veteran of U.S. Armed Forces, ,'? July 4,2015 87 War or Dates 1 Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital W Manner of Death LXI Natural Cause , I Accident Homicide Suicide Undetermined Pending Circumstances Investigation Medical Certifier Name Title Howard E. Silverberg Address 100 Park Street,Glens Falls,NY 12801 Death Certificate Filed District Number Re ter Number 1 City, Town or Village CIO Glens Falls 5601 U ❑Burial Date Cemetery or Crematory July 7,2015 Pine View Crematory Entombment Address ©Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed Z — Removal and/or Held O - l and/or Address E Hold Cl) O Date Point of N Transportation Shipment a by Common Destination Carrier Disinterment Date Cemetery Address pi Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander-Baker Funeral Home 00035 °; Address c,, 3809 Main Street,Warrensburg,NY 12885 Name of Funeral Firm Making Disposition or to Whom t. Remains are Shipped, If Other than Above Address W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued Z t b 1 15"- Registrar of Vital Statistics U0 tA.Jv u d•—ct (signature) District Number 5601 Place C/O Glens Falls t- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: w Date of Disposition 711)1 S Place of Disposition ZU , ev ,rta,. W (address) co cc (section) I .,(lot numbs) (grave number) pName of Sexton or Person in Charge of PremisestpL i Z (please print) W Signature G�/ i-- Title (7,tyi}Dlit.. (over) DOH-1555(02/2004)