Oddy, Michael James NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Michael James Oddy Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/30/2021 69 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address 24 West Notre Dame Street D,Glens Falls,New York 12801
UJ
Manner of Death ❑X Natural Cause ❑Accident ❑Homicide El Suicide 0 Undetermined El Pending
W Circumstances Investigation
W Medical Certifier Name Title
Aqeel Gillani MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 477
Burial Date Cemetery,Crematory or Facility Name
11/02/2021 Pine View Crematory
❑Entombment Address
0 Cremation Queensbury Town,New York
Donation
ZO ❑Removal Date Place Removed
and/or and/or Held
Hold Address
N
0
G. Date Point of
(!) U Transportation Shipment
Q by Common
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
0 Reinterment
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F Remains are Shipped,If Other than Above
2 Address
CC
W
0-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/02/2021 Registrar of Vital Statistics 10-ert_nnarrezv Curtis(Efectronicad:ySignerl9
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I— )
Z Date of Disposition II/'I 111 Place of Disposition rr►F(�.
W (a dress)
W
CC N (section) Allot number) �, (grave number)
0a Name of Sexton or Person in Charge of Premi es " i —'",4 1 r
(ple e print)
Z �Rwrt► T�
W Signature L/ Title l Wj
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#