Windedal, Olav NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
OLAV WINDEDAL MALE
Date of Death Age If Veteran of U.S. Armed Forces,
11/27/1996 62 War or Dates KOREAN
Place of Death Hospital, Institution or
City, Town or Village GLENS FALLS Street Address GLENS FALLS HOSPITAL
Manner of Death Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
ORANDO MARTELO M. D.
Address
102 PARK STREET GLENS FALLS, NY 12801
Death Certificate Filed District Number Register Number
>[ City, Town or Village GLENS FALLS 5601 598
Date Cemetery or Crematory
❑Burial 12/02/1996 PINE VIEW CREMATORY
Address
®Cremation AUEENSBURY, NY 12804
Date Place Removed
❑Removal and/or Held
... and/or Address
Hold
Date Point of
NQ Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
>' Permit Issued to Registration Number
Name of Funeral Home K.B. KILMER FUNERAL HOME 01057
Address
136 MAIN STREET SOUTH GLENS FALLS, NY
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above a di ated.
Date Issued 6 Registrar of Vital Statistics ''�D� / C/ " ze
(signature)
District Number5601 Place GLENS FALLS
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
i
z Date of Disposition-- Place of Disposition sW. /1l,�!//•�C�1 ��1 /�f� R/ 4,1/0
(address)
UJI
(section) (lot number) (grave number)
GName of Sexto or Person in Char2ofremises Z:-OD/9�-pF (please print)
Signature cv� Title
DOH-1555 (10/89) p. 1 of 2 VS-61