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Ovchar, Viktoriia NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Viktoriia Ovchar Female Date of Death Age If Veteran of U.S.Armed Forces, 12/23/2020 84 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address 58 4th Street,Glens Falls,New York 12801 ❑ Manner of Death ©Natural Cause ❑Accident El Homicide ❑Suicide El Undetermined ❑Pending W Circumstances Investigation U W Medical Certifier Name Title O Patricia Stevenson PA Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 591 0 Burial Date Cemetery,Crematory or Facility Name 12/26/2020 Pine View Crematorium ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation Z Date Place Removed 0 0 Removal and/or and/or Held NH Hold Address 0 d Date Point of f/)❑Transportation El Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom E Remains are Shipped,If Other than Above 5 Address CC W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/24/2020 Registrar of Vital Statistics Rp6ert Andrew Curtis(ECectronically Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: • Date of Disposition /�-r���t�2r) Place of Disposition ; J e if,64 Clam,hA g (addr w CCCC (section) not number (grave number) O Atil_KND.AlD cod Name of Sexton or Person in Char of Premis (please print) W Signature Title De.-e_skia.r DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of v' } r 'v delivered on .' , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#