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Ottens, Harry (2)
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 LU 0 Manner of Death ©Natural Cause Accident Homicide ❑Suicide 0 Undetermined El Pending W Circumstances Investigation W Medical Certifier Name Title 0 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 O Burial Date Cemetery,Crematory or Facility Name 08/18/2021 Pine View Crematory 0 Entombment Address X❑Cremation Queensbury,New York ElDonation ZO❑Removal Date Place Removed and/or and/or Held i` Hold Address N 0 Date Point of V)❑Transportation Shipment 0 by Common Carrier Destination El 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 i- Remains are Shipped,If Other than Above 2 Address Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/16/2021 Registrar of Vital Statistics Caroline Wf 1egarIe Barber(ECectronicatty 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 1g il$/Zf Place of Disposition X1n4.... L-a---% W (address) ILLI CO (section) / (lot number/ �y (grave number) 8 Name of Sexton or Person in Charge of P ises (��I" L .4t (plaice print) z 6Title /P'dTOK ▪ Signature DOH-1555(07/18)p 1 of 2 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#