Olden, Alfred ft
NEW YORK STATE DEPARTMENT OF HEAI,,TH , `" I
Vital Records Section Burial - Transit Permit
n' Name First Middle Last Sex
Alfred Leslie Olden Male
Date of Death Age If Veteran of U.S. Armed Forces,
f-: September 6,2012 84 War or Dates Korean
:} : Place of Death Hospital, Institution or
Z: City, Town or Village Glens Falls Street Address Glens Falls Hospital
41
Manner of Death X Natural Cause I 'Accident Homicide Suicide Undetermined Pending
(114 Circumstances Investigation
to Medical Certifier Name Title
: Nancy Carney Dr.
Address
-' BERN,Wrg.,NY 12885
Death Certificate Filed District Number Regi$teerr Number
r ".7: : City, Town or Village Glens Falls 5601
❑Burial Date Cemetery or Crematory
Entombment September 7,2012 Pine View Crematory
Address
0 Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z Removal i and/or Held
and/or Address
H Hold
N
O Date Point of
coTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
`v° Permit Issued to Registration Number
:4=; Name of Funeral Home Alexander-Baker Funeral Home 00035
{a Address
m 3809 Main Street,Warrensburg,NY 12885
:' Name of Funeral Firm Making Disposition or to Whom
IM. Remains are Shipped, If Other than Above
IAddress
• Permission is hereby granted to dispose of the human remains described above as indicated.
1
Date Issued C f `I ! " 2 Registrar of Vital Statistics '/`lQ.• -Q R
U (signatur
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition °I-10-)1 Place of Disposition 11,Aa../ Ci4,--{octy-
W (address)
N
Ce (section) i , lot number) (grave number)
pName of Sexton or Person in Charge f Premises ((( t,a r' 3 Chnl
ZAIL (please print)
W Signature Title CQ.r tA f
(over)
DOH-1555 (02/2004)