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Osborne, Jane A.
)3 2� NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Jane A.Osborne Female Date of Death Age If Veteran of U.S.Armed Forces, 12/18/2020 86 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death ©Natural Cause ❑Accident 0 Homicide Ej Suicide ID Undetermined Pending W Circumstances Investigation U W Medical Certifier Name Title a William Cleaver MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 581 LiBurial Date Cemetery,Crematory or Facility Name 12/21/2020 Pine View Crematory ElEntombment Address 0 Cremation Queensbury Town,New York El Donation Date Place Removed Removal and/or Held H and/or Hold Address 0 Date Point of (I) Li Transportation Shipment p by Common Carrier Destination El Disinterment Date Cemetery Address Date Cemetery Address ElReinterment Permit Issued to Registration Number Name of Funeral Home Miller Funeral Home 01199 Address 6357 Nys Rte#30, Indian Lake,New York 12842 Name of Funeral Firm Making Disposition or to Whom F— Remains are Shipped,If Other than Above 2 Address CC W CL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/21/2020 Registrar of Vital Statistics Robert Andrew Curtis(Electronically 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: Z Date of Disposition n..-ZZ-2'JW Place of Disposition Pdie,,Vtau) � �a G , .-a (1J (address) U) / (lot number) (grave number) LU t C 0 (section) V• V✓f(i. � • Name of Sexton or Per i arge of Premises ` wr ` (please print) Z � dy� W Signature Title cfe, DOH-1555(07/18) 1 of 2 Public Health Law Sec. 4145(2b)- 014316 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#