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Olden, Marylou NEW YORK STATE DEPARTMENT OF HEALTH I 11 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Marylou Olden Female Date of Death Age If Veteran of U.S. Armed Forces, February 20,2014 70 War or Dates f. Place of Death Hospital, Institution or Z; City, Town or Village Glens Falls Street Address Glens Falls Hospital 0A Manner of Death X Natural Cause Accident n Homicide Suicide Undetermined Pending Circumstances Investigation w' Medical Certifier Name Title Gamal G.Khalifa MD Address Glens Falls Hospital, 100 Park Street,Glens Falls,NY 12801 Death Certificate Filed District Number Register Nu ber City, Town or Village C/0 Glens Falls 5601 e` ❑Burial Date Cemetery or Crematory 02/21/2014 Pine View Crematory 0 Entombment Address ®Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed Z n Removal and/or Held O and/or Address H Hold N O Date Point of a. Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander-Baker Funeral Home 00037 I Address 3809 Main Street,Warrensburg,NY 12885 Name of Funeral Firm Making Disposition or to Whom I.-, Remains are Shipped, If Other than Above , Address fe tiJ a` Permission is hereby granted to dispose of the human remains describe abo as indicated. Date Issued ©0Z,7,2//�0/j� Registrar of Vital Statistics %Lii 6' J (signature) District Number 5601 Place Glens Falls I certify that the remains of the decedent identified above were disposed ofin accordance with this permit on: w Date of Disposition a Kati IN( Place of Disposition iti,U=") Caw,., W (address) CO rL (section) (I t numbTyN (grave number) p0 Name of Sexton or Pers in Charge f Premises dir Un Z lease print) W Signature 7— Title CiLI�O+t�t7//t I (over) DOH-1555 (02/2004)