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Olden, John E. y 3°b NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John E.Olden Male `, Date of Death Age If Veteran of U.S.Armed Forces, '; 05/18/2021 87 Years War or Dates t,, Place of Death Hospital,Institution or Z City,Town or Village Warrensburg Town Street Address 141 River Street,Warrensburg Town,New York 12885 Wp Manner of Death ©Natural Cause 1=1 Accident 1=1 Homicide ❑Suicide ❑Undetermined 1=1 Pending W Circumstances Investigation U.1, Medical Certifier Name Title Mary Stein NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Warrensburg 5660 16 1-1 Burial Date Cemetery,Crematory or Facility Name 05/20/2021 Pine View Crematory ❑Entombment Address ElCremation Queensbury Town,New York 12 Donation 0❑Removal Date Place Removed and/or and/or Held N Hold Address a0. Date Point of N Li Transportation Shipment Ca by Common Carrier Destination ❑Disinterment Date Cemetery Address ._ Reinterment Date Cemetery Address ElY rPermit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 ir- Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom i.., Remains are Shipped,If Other than Above 2 Address CC Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/19/2021 Registrar of Vital Statistics Tame&a M G(oyrf(E(ectronically Signed) (signature) District Number 5660 Place Warrensburg, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: &N.-- z Date of Disposition SI WI iI Place of Disposition W (address) W N (section) (l number/ (grave number) Name of Sexton or Person in Charge of emises h'` L 4/11 Z please pr t) ii , Signature Title arz.042,2 DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) 014804 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#