Odell Jr., Harold G 41
IS
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Pe mi
Name First Middle Last Sex
Harold G.Odell Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
06/09/2021 73 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Lake George Town Street Address 180 Middle Road, Lake George Town, New York 12845
fW Manner of Death
xiW Natural Cause 0 Accident El Homicide ❑Suicide ❑Undetermined ElPending
U Circumstances Investigation
1JJQ Medical Certifier Name Title
Edward Liebers MD
Address
3 Care Lane,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Lake George 5651 11
Burial Date Cemetery,Crematory or Facility Name
06/14/2021 Pine View Crematory
❑Entombment Address
lCremation Queensbury Town,New York
❑Donation
Z Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
0
O. Date Point of
co Li Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
2 Address
CC
uJ
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/14/2021 Registrar of Vital Statistics Patricia R vicxjnney Schuster(ECectronicaltySigned)
(signature)
District Number 5651 Place Lake George, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition Will 1 Place of Disposition 4. t,�,`(� `,
2 (address)
W
(I)
CC (section) ` (lloot�iumber) (grave number)
CName of Sexton or Person in Charge of remises G 14 v'1 L ,,,►4Ig-
Z (phase pant)
W Signature Title �/"yl}�✓�
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 0 1 6 2
Receipt r
1
Human remains ofdelivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#