O'Dell, Wiley NEW YORK STATE DEPARTMENT OF HEALTH � , Burial _ Transit Permit
Vital Records Section
"}4°y Name First Middle Last Sex
_°° Wiley E. O'Dell Male
Date of Death Age If Veteran of U.S. Armed Forces,
' ;i` November 23,2013 60 War or Dates
iPlace of Death Hospital, Institution or
City, Town or Village Thurman Street Address 627 Mountain Road
Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Paul Bachman MD
Address
� HHHN,Warrensburg,NY 12885
• Death Certificate Filed District Number Register Number
City, Town or Village Thurman 5659 3
❑Burial Date Cemetery or Crematory
November 25,2013 Pine View Crematory
0 Entombment Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
CO
O Date Point of
O.
Transportation Shipment
p by Common Destination
Carrier
Li Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
• . Permit Issued to Registration Number
e a Name of Funeral Home Alexander-Baker Funeral Home 00037
'' Address
• 3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
»; Remains are Shipped, If Other than Above
Si Address
• P::::
is he eby_granted to dispose of the human r ins de cribed e s ' dic ed.
j
�/ /)3 Registrar of Vital Statistics
(signature)
District Number 5659 Place Thurman
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
LLI Date of Disposition II-/9-0 Place of Disposition Z A 6-4 `Vre „
W (address)
Cl)
1Y (section) (lot number) (grave number)
Q Name of Sexton or Person in harge of Premises /.,, t,- _Qst* _
ZL (plse print)
W Signature `'� , Title G1l piAroiw
1
(over)
DOH-1555 (02/2004)