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LaPell, Olga M
4 Of NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Olga M.LaPell Female Date of Death Age If Veteran of U.S.Armed Forces, 07/31/2021 90 Years War or Dates 1N Place of Death Hospital,Institution or WCity,Town or Village Chester Town Warren Street Address 114 State Route 28 N Route,Chester Town Warren,New York 12853 p Manner of Death ©Natural Cause ❑Accident ❑Homicide El Suicide u Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title CI Kate Sauer-Jones PA Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Chestertown 5652 12 ❑Burial Date Cemetery,Crematory or Facility Name 08/03/2021 Pine View Crematory EiEntombment Address ElCremation Queensbury Town,New York ❑Donation Date Place Removed O Removal and/or Held rz and/or N Hold Address Q. Date Point of U) L j Transportation Shipment p by Common Carrier Destination Ei Disinterment Date Cemetery Address Date Cemetery Address ❑Reinterment Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 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 0. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/03/2021 Registrar of Vital Statistics 9►1incfy Conway(ECectronicaffySigned) /signature/ District Number 5652 Place Chestertown, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: a W▪ Date of Disposition gih 1i Place of Disposition ,(address/ 2 W co cc (section) of number) (grave number) Q Name of Sexton or Person in Charge of Premises F l� Ste'" t z (please rint) /� Ill411 Signature Title [e il" 1 DOH-1555(07/18)p 1 of 2 E� 3 Public Health Law Sec. 4145(2b) Receipt Human remains of - _., delivered on `' , 20 Pine View Cemetery •- Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#