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Ottens, Harry c _ A6,g3 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Harry Ottens Male Date of Death Age If Veteran of US.Armed Forces, 08/15/2021 88 Years War or Dates 1950-1953 Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 52 Old Mill Lane,Queensbury Town,New York 12804 pManner of Death ©Natural Cause ❑Accident ❑Homicide El Suicide ❑Undetermined El Pending W Circumstances Investigation W Medical Certifier Name Title G Alexis Mondella NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 171 EIBurial Date Cemetery,Crematory or Facility Name 08/18/2021 Pine View Crematory ElEntombment Address ElCremation Queensbury,New York Donation Removal Date Place Removed and/or and/or Held F Hold Address 0 a. Date Point of to ❑Transportation Shipment p by Common Carrier Destination . Disinterment Date Cemetery Address Ej 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 F- Remains are Shipped,If Other than Above `f Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/16/2021 Registrar of Vital Statistics Caroline 21iil6egarle Barber(Electronically Signed) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition g/l$'j' Place of Disposition 211/11... i -the- W (address) W U) CC (section) ii (lot number) �y (grave number) SName of Sexton or Person in Charge of P ises ^" 'I Z 1ple print) W � Title � /w4T�K Signature DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 i /; Pine View Cemetery Representing the funeral home named pg,buria,permit i Official Funeral Directors Reg.or License#